title: Recommendations for bowel obstruction with peritoneal carcinomatosis.
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.
authors.affiliation: Palliative and Supportive Care Mobile Unit, University Hospital Center, Grenoble, France. Electronic address: glaval@chu-grenoble.fr.
authors.forename: Guillemette
authors.initials: G
authors.lastname: Laval
authors.affiliation: Palliative and Supportive Care Mobile Unit, HCL, Lyon, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Marcelin-Benazech
authors.affiliation: Medical House Jeanne Garnier, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Guirimand
authors.affiliation: Department of Medical Oncology, Hospital Hôtel Dieu, APHP, Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Chauvenet
authors.affiliation: Department of Medical Oncology, Institute Curie, Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Copel
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital Center, Grenoble, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Durand
authors.affiliation: Antoine Lacassagne Cancer Center, Nice, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Francois
authors.affiliation: Palliative Care Unit, Hospital Paul Brousse, APHP, Villejuif, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gabolde
authors.affiliation: Department of Digestive Surgery, Institute Curie, Paris, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Mariani
authors.affiliation: Oncology Day Hospital, University Hospital Center, Grenoble, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Rebischung
authors.affiliation: Department of Radiology, Institute Curie, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Servois
authors.affiliation: Department of Hepato-Gastroenterology, Hospital du haut Levêque, Pessac, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Terrebonne
authors.affiliation: Department of Digestive Surgery, University Hospital Center, Grenoble, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Arvieux
mesh_terms: D002277:Carcinoma / Q000150:complications* / Q000556:secondary; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000150:complications* / Q000556:secondary; D011379:Prognosis; D014057:Tomography, X-Ray Computed
keywords: Peritoneal carcinomatosis; corticosteroids; malignant bowel obstruction; palliative care; proton-pump inhibitors; somatostatin analogues; stents; supportive care; venting gastrostomy