Medical management of intestinal obstruction in terminal care.

OBJECTIVE: To review the evidence on the effectiveness of medical management of bowel obstruction for patients with advanced cancer and to summarize treatment options for home and hospital care. DATA SOURCES: Articles were identified by searching MEDLINE. STUDY SELECTION: Research articles published between 1973 and 1995 on the surgical and medical management of bowel obstruction in patients with advanced cancer were identified. Seven original research articles on medical management were identified and all were reviewed and critically appraised. Given the small number of original papers in this field, studies using prospective and retrospective methodology were included. Articles looking only at the use of percutaneous gastrostomy tubes and subcutaneous hydration were used in the formulation of treatment recommendations but were not critically reviewed. A critical appraisal of the surgical literature was not undertaken. SYNTHESIS: Recommendations regarding medical management of bowel obstruction were based on strength of evidence for improving symptoms with pharmacologic treatment. The few clinical trials were uncontrolled trials with small samples. The trials show improvement of symptom control with pharmacologic management using morphine, anticholinergics, major tranquilizers, corticosteroids, and somatostatin analogues. Intravenous hydration was unnecessary for most patients. Percutaneous gastrostomy tubes are effective for patients with proximal intestinal obstruction and intractable vomiting.
CONCLUSIONS: Pharmacologic management and percutaneous gastrostomy for intractable vomiting and hypodermoclysis or oral fluids for hydration can control symptoms without surgery or nasogastric tubes.