Recommendations for Bowel Obstruction With Peritoneal Carcinomatosis

 Journal of Pain and Symptom Management
Volume 48, Issue 1 , Pages 75-91, July 2014

• Guillemette Laval, MD
,
• Blandine Marcelin-Benazech, MD
,
• Frédéric Guirimand, MD
,
• Laure Chauvenet, MD
,
• Laure Copel, MD
,
• Aurélie Durand, MD
,
• Eric Francois, MD
,
• Martine Gabolde, MD
,
• Pascale Mariani, MD
,
• Christine Rebischung, MD
,
• Vincent Servois, MD
,
• Eric Terrebonne, MD
,
• Catherine Arvieux, MD
,
• French Society for Palliative Care, with the French Society for Digestive Surgery, the French Society for Gastroenterology, the French Society for Digestive Cancer, and the French Association for Supportive Care in Oncology

Accepted 28 August 2013. published online 05 May 2014.

Abstract 

This article reports on the clinical practice guidelines developed by a multidisciplinary group working on the indications and uses of the various available treatment options for relieving intestinal obstruction or its symptoms in patients with peritoneal carcinomatosis. 

These guidelines are based on a literature review and expert opinion. 

The recommended strategy involves a clinical and radiological evaluation, of which CT of the abdomen is a crucial component. 

The results, together with an analysis of the prognostic criteria, are used to determine whether surgery or stenting is the best option. In most patients, however, neither option is feasible, and the main emphasis, therefore, is on the role and administration of various symptomatic medications such as glucocorticoids, antiemetic agents, analgesics, and antisecretory agents (anticholinergic drugs, somatostatin analogues, and proton-pump inhibitors). 

Nasogastric tube feeding is no longer used routinely and should instead be discussed on a case-by-case basis. Recent studies have confirmed the efficacy of somatostatin analogues in relieving obstruction-related symptoms such as nausea, vomiting, and pain. However, the absence of a marketing license and the high cost of these drugs limit their use as the first-line treatment, except in highly selected patients (early recurrence). When these medications fail to alleviate the symptoms of obstruction, venting gastrostomy should be considered promptly. Rehydration is needed for virtually every patient. Parenteral nutrition and pain management should be adjusted according to the patient needs and guidelines.

Key Words: Peritoneal carcinomatosis, malignant bowel obstruction, palliative care, supportive care, somatostatin analogues, venting gastrostomy, stents, proton-pump inhibitors, corticosteroids