Octreotide for Small Bowel Obstruction
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.
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