Table of contents
Malignant bowel obstruction
Guidelines
Key sources
The following summarized guidelines for the management of malignant bowel obstruction are prepared by our editorial team based on guidelines from the Multinational Association of Supportive Care in Cancer (MASCC 2022), the American Gastroenterological Association (AGA 2021), the European Society of Medical Oncology (ESMO 2021,2020), the Eastern Association for the Surgery of Trauma (EAST 2016), and the Multinational Association of ...
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Medical management
Antiemetics: as per MASCC 2022 guidelines, consider administering octreotide to reduce vomiting in patients with MBO.
C
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Laxatives
Corticosteroids
Opioids
Anticholinergics
Water-soluble contrast agents
Nonpharmacologic interventions
Nutritional support: as per MASCC 2022 guidelines, keep the patient NPO initially when diagnosed with MBO, and then switch to a symptom-led, slow and graded reintroduction to oral diet when acute MBO resolves fully or partially, including clear fluids, free or full fluids, texture-modified low-fiber diet (soft, minced, and pureed) and if tolerated back to normal-textured low-fiber diet.
B
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Therapeutic procedures
General principles: as per AGA 2021 guidelines, decide on specific interventions in patients with alimentary tract obstruction in a multidisciplinary setting including oncologists, surgeons and endoscopists and take into account the characteristics of the obstruction, patient's expectations, prognosis, expected subsequent therapies and functional status.
E
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Bowel decompression
Self-expanding metallic stents
Surgical interventions
Palliative surgery
As per MASCC 2022 guidelines:
Consider performing palliative surgical intervention in highly selected patients with a multi-level obstruction.
C
Consider performing less invasive surgical interventions in patients with advanced cancer undergoing palliative surgery for MBO because of high risk of surgical complications.
C
Specific circumstances
Patients with rectal tenesmus: as per ESMO 2020 guidelines, offer the following options for the management of malignancy-associated (colorectal or other pelvic tumor) rectal tenesmus:
diltiazem PO 30 mg every 6 hours
topical methadone 2% 2.5 mg every hour
methadone PO 2.5 mg every 8 hours with titration
nifedipine PO 10-20 mg every 12 hours.
B