Octreotide for Malignant Bowel Obstruction – pro

Malignant bowel obstruction (MBO) is a common and very difficult problem to manage at the end of the course of ovarian cancer, Surgery can help but is not always possible and often only temporarily effective. It should not be undertaken in patients known to have poor prognostic criteria for surgical intervention such as intra-abdominal carcinomatosis, poor performance status and massive ascites. Nasogastric drainage should generally only be a temporary measure and is nto comfortable. Self-expanding metallic stents are an option in malignant obstruction of the gastric outlet, proximal small bowel and colon. Medical  treatment of pain and anuses can help. Soomatostatin analogues (e.g. octreotide) reduce gastrointestinal secretions and a number of reports over the last two decades confirm its limited but significant place in treating MBO. Octreotide can reduce secretions with or without anticholinergics , such as hyoscine hydrobromide. Octreotide can also diminish the hypertensive state in the lumen that causes the distension-secretion-distention cycle, which can lead to total obstruction if not treated.

Two randomized prospective studies were  and a recent combination study with with metoclopramide, dexamethasone confirm octreotide effectiveness in MBO.

Ripamonti C, Mercadante S, Groff L, Zecca E, De Conno F, Casuccio A. Role of octreotide, scopolamine butylbromide and hydration in symptom control of patients with inoperable bowel obstruction having a nasogastric tube. A prospective, randomized clinical trial. J Pain Symptom Manage 2000;19:23–34.

Mercadante S, Ripamonti C, Casuccio A, Zecca E, Groff L. Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Supportive Care in Cancer 2000;8:188–91.

Carla Id, Ripamonti, Alexandra M. Easson, Hans Gerdes Management of malignant bowel obstruction Eur J Cancer 4 4 ( 2 0 0 8 ) 1 1 0 5 –1 1 1 5

Cancer Care Ontraion, https://fr.cancercare.on.ca/common/pages/UserFile.aspx?fileId=34421, 2003

Yasuo Shima et al, Clinical Efficacy and Safety of Octreotide (SMS201-995) in Terminally Ill Japanese Cancer Patients with Malignant Bowel Obstruction Jpn. J. Clin. Oncol. (2008) 38 (5): 354-359

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