[Pharmacological treatment of malignant bowel obstruction in severely ill and dying patients : a systematic literature review].
BACKGROUND
Malignant bowel obstruction (MBO) occurs in 3-6% of patients suffering from advanced cancer. The incidence of MBO is highest in patients with gynaecological and colorectal malignancies. Typical symptoms include nausea, vomiting, abdominal pain and constipation. Initially, these symptoms may be isolated and sporadic, becoming more and more intense later on. The suggested treatment includes surgical, interventional and pharmacological strategies depending on the symptom pattern and the performance status of the patient. This study investigates the current evidence of pharmacological treatment for MBO during the last days of life.


METHODS
A systematic literature search of the electronic databases PubMed/Medline and Embase from 1966-2011 was conducted. All retrieved publications were screened for relevance with regard to content and methodology on the basis of title and abstract. The full text was obtained for all relevant articles and for those articles where classification was unsure.


RESULTS
The systematic literature search identified 5,431 papers. After screening, 90 publications were analyzed in detail. A total of 69 publications were excluded due to content or methodology. Finally, 21 manuscripts were considered for review. Only a few studies used high quality methodology and they all had rather small sample sizes. In summary, they show weak positive signs of efficacy for the use of somatostatin analogues or anticholinergics in the pharmacological treatment of MBO.


CONCLUSIONS
These results do not lead to a clear evidence base for the pharmacological treatment of MBO in the last days of life. As adverse events were infrequent and clinical studies suggest efficient symptom relief, the authors recommend the use of octreotide as the first line medication. Butylscopolamine may be an alternative, where octreotide is not available. Higher costs for octreotide compared with butylscopolamine have to be considered. Available data do not allow assessing the effect of corticosteroids on symptoms caused by MBO when given during the last days of life.                 The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").
Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland. carsten.klein@uk-erlangen.de
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D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002086:Butylscopolammonium Bromide / Q000009:adverse effects / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy* / Q000209:etiology; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use; D010166:Palliative Care / Q000379:methods*; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D013727:Terminal Care / Q000379:methods*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D018680:Cholinergic Antagonists; D002086:Butylscopolammonium Bromide; D013004:Somatostatin; D015282:Octreotide