[Palliative treatment in gastroenterology at the border to (abdominal) surgery]

In the management of gastrointestinal tumour lesions, palliative treatment has attained an increasing role. As also in curative treatment, an interdisciplinary cooperation between gastroenterologists and surgeons has to be aimed for.

The aim of this study is to illustrate the diagnostic and therapeutic management of frequently occurring diseases in palliative medicine from a gastroenterological point of view.

Complementary short overviews on clinical experience and selectively searched references from the current scientific literature were evaluated.

The symptomatic complex is very heterogeneous and requires an adequate approach taking into account the differential diagnosis. The palliative gastroenterological approach is characterised by the competent care on ascites, management of "malignant intestinal obstruction and obstipation" (MIO) as well as appropriate nutrition and analgetic therapy. The surgical approach is indicated after sequential exhaustion of medical, interventional endoscopic and (eventually) image-guided radiological measures; it comprises creation of a peritoneovenous shunt (ascites), bypass procedures (gastroenteral, biliodigestive, enteroenteral) as well as, in extraordinary cases, resection in addition to the implantation of an i. v. port-a-cath or surgical revision of a PEG / stent complication; in particular, in case of recurrent and massive haemorrhage and perforation (absolute indication), surgery becomes necessary.

A lack of appropriate studies, absence of adequate study results including the difficult initiation of medical studies with palliative intention aggravate a competent evidence-based approach. Therefore, the management is considerably affected by clinical experience.

Efficacious care in palliative visceral medicine requires relevant clinical expertise and interdisciplinary action because of the occurrence of clinical cases in gastroenterology at the border to surgery.