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Inoperable malignant bowel obstruction: palliative interventions outcomes - mixed-methods systematic review.

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Summary

Parenteral nutrition (PN) and palliative venting gastrostomies (PVG) offer patients valuable time at home and improve quality of life for inoperable malignant bowel obstruction (MBO). However, evidence on survival benefits remains inconclusive, necessitating further research.

Keywords:
Gastrointestinal (lower)Gastrointestinal (upper)GenitourinaryIntestinal obstructionQuality of life

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Area of Science:

  • Oncology
  • Gastroenterology
  • Palliative Care

Background:

  • Malignant bowel obstruction (MBO) management often involves parenteral nutrition (PN) and palliative venting gastrostomies (PVG).
  • Limited data exist on the clinical and quality-of-life outcomes of PN and PVG in inoperable MBO.
  • Informing clinical decision-making requires a better understanding of these interventions' impact.

Approach:

  • A mixed-methods systematic review and narrative synthesis was conducted.
  • Extensive database searches (MEDLINE, Embase, Cochrane, etc.) were performed up to April 2021.
  • Included studies were independently screened and quality appraised.

Key Points:

  • Forty-seven studies with 3538 participants were included in the review.
  • PN and PVG appear to provide patients with valuable time at home and improve quality of life, despite burdens.
  • PVG offers relief from nausea and vomiting; PN may maintain or improve nutritional and performance status.

Conclusions:

  • Current evidence does not confirm survival benefits from PN or PVG for inoperable MBO.
  • Patient and clinician beliefs support the use of these interventions for perceived benefits.
  • Well-designed randomized controlled trials are needed to definitively assess survival outcomes, addressing concerns about equipoise.