MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer
MASCC · 2022 · international
Source and licence
- Authors
- Ainhoa Madariaga, Jenny Lau, Arunangshu Ghoshal et al.
- Title
- MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer
- Journal
- Supportive Care in Cancer, 2022
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC9046338
Licence statement of the original publication
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Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Anticholinergics
- Suggestion: The benefit of anticholinergics (hyoscine butylbromide) may be inferior to octreotide to reduce vomiting in MBO.Level of evidence: III; Grade: D
Dopamine antagonist prokinetic
- Suggestion: Dopamine antagonist prokinetic drugs (e.g., metoclopramide, domperidone) may be effective for the management of nausea, vomiting, and restoring bowel transit time in partial MBO. Due to the potential increased risk of bowel perforation, it likely should be avoided in complete MBO.level of evidence: III; grade B
Histamine (H1) antagonist
- Suggestion: Histamine H 1 antagonists (e.g., dimenhydrinate, cyclizine) may be an effective anti-emetic in complete MBOlevel of evidence: IV; grade D
Phenothiazines
- Suggestion: Phenothiazines (e.g., chlorpromazine) may reduce nausea and vomiting in MBOlevel of evidence: IV; grade: D
Serotonin (5-HT3) antagonists
- Suggestion: Granisetron, serotonin (5HT 3 ) antagonist may reduce nausea and the frequency of vomiting in MBOlevel of evidence: III; grade D
Somatostatin analog
- RecommendationSomatostatin analog (octreotide, lanreotide) may reduce vomiting in MBOlevels of evidence: I; grade A
Thienobenzodiazepene (second-generation) antipsychotic
- Suggestion: Thienobenzodiazepene antipsychotic (e.g., olanzapine) may reduce nausea and vomiting in MBOlevel of evidence: IV; grade: D
Laxatives
- Suggestion: Oral osmotic laxatives should be considered in the management of impaired bowel movements in partial bowel obstruction but should be avoided in complete MBOlevel of evidence: V; grade: D
Opioids
- Suggestion: Opioids are commonly used to treat pain associated with MBO, but there is no evidence to support their uselevel of evidence: V; grade D
Anticholinergics
- Suggestion: The benefit of anticholinergics (hyoscine butylbromide) may be effective to reduce abdominal pain in MBOlevel of evidence: III; grade: D
Corticosteroids
- Suggestion: The use of steroids may help with the acute symptoms of MBO and can be used for short-term benefitlevel of evidence: III; grade: B
Oral water-soluble contrasts
- No guideline possible. There are insufficient data to determine the efficacy of oral water-soluble contrasts in MBOlevel of evidence: V; grade D
Nasogastric tube
- Suggestion: Nasogastric tube may be used for temporary decompression in acute MBOlevel of evidence: V; grade: D
Endoscopic or percutaneous gastrostomy tube
- Suggestion: Endoscopic or percutaneous gastrostomy tube may be used for gastric decompression in MBOlevel of evidence: IV; grade B evidence
Percutaneous transesophageal gastro-tubing
- Suggestion: Percutaneous transesophageal gastro-tubing may be used for gastric decompression in MBOlevel of evidence: IV; grade: C
Diet
- Suggestions: • When a patient is initially diagnosed with MBO, they should be made Nil Per Os (NPO; nothing by mouth), and then when the acute MBO resolves fully or partially, a symptom led, slow and graded reintroduction to oral diet is recommended. This may include clear fluids, free or full fluids, texture modified low fiber diet (soft, minced, and pureed), and if tolerated, back to normal textured low fiber diet (level of evidence: IV; grade: B). • Nutrition interventions should be initiated in patients with advanced cancers only where the benefits of these interventions on quality of life and survival outweigh the risks, with clear expectations discussed by a multidisciplinary team with patients and familieslevel of evidence: IV; grade: B
Parenteral nutrition
- Suggestions: • HPN may be beneficial and maintain the quality of life in a very selected group of patients with MBO (level of evidence: IV; grade: D). • Central venous access is preferred for HPN delivery (level III, grade: B). • In end-of-life HPN, should be discontinued (or not initiated) as it raises the risk of complications and may prolong sufferinglevel of evidence: V; grade: D
Abstract
Purpose: To provide evidence-based recommendations on the management of malignant bowel obstruction (MBO) for patients with advanced cancer.
Methods: The Multinational Association for Supportive Care in Cancer (MASCC) MBO study group conducted a systematic review of databases (inception to March 2021) to identify studies about patients with advanced cancer and MBO that reported on the following outcomes: symptom management, bowel obstruction resolution, prognosis, overall survival, and quality of life. The review was restricted to studies published in English, but no restrictions were placed on publication year, country, and study type. As per the MASCC Guidelines Policy, the findings were synthesized to determine the levels of evidence to support each MBO intervention and, ultimately, the graded recommendations and suggestions.
Results: The systematic review identified 17,656 published studies and 397 selected for the guidelines. The MASCC study group developed a total of 25 evidence-based suggestions and recommendations about the management of MBO-related nausea and vomiting, bowel movements, pain, inflammation, bowel decompression, and nutrition. Expert consensus-based guidance about advanced care planning and psychosocial support is also provided.
Conclusion: This MASCC Guideline provides comprehensive, evidence-based recommendations about MBO management for patients with advanced cancer.
Supplementary Information: The online version contains supplementary material available at 10.1007/s00520-022-06889-8.
Contents of the original publication
The section headings of the original.
- Introduction
- Background
- Etiology
- Pathophysiology and symptoms
- Diagnosis
- Advanced care planning and goals of care conversations
- Methods
- Literature review
- Suggestions/recommendations
- Anti-emetics
- Analgesics
- Bowel decompression
- Nutrition
- Psychosocial support
- Conclusion
- Authors contribution
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