Hépato-Gastro & Oncologie Digestive


Management of malignant bowel obstruction of digestive cancer Volume 20, issue 4, Avril 2013


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CHU de Poitiers, service d’hépato-gastro-entérologie, 2 rue de la Milétrie, 86000 Poitiers Cedex, France, Université de Poitiers, EA 4331, laboratoire Inflammation Tissus Epithéliaux et Cytokines, avenue du recteur Pineau, 86022 Poitiers Cedex, France, CHU de Poitiers, service de radiologie, 2 rue de la Milétrie, 86000 Poitiers Cedex, France

Nearly 25% of digestive cancers will develop during their history a peritoneal carcinosis (PC). Diagnosis of occlusion due to CP is difficult and based on CT-scan which furthermore rules out other diagnoses. The main treatment goal is to recover normal transit, to preserve patients’ quality of life and to allow his back home. There is no longer strong level of evidence on therapy used. The efficacy of corticosteroids has not been demonstrated in randomized trials, in contrast to scopolamine. Octreotide has greater efficiency than scopolamine. A combination of octreotide, corticosteroids and symptomatic treatment is the most effective therapeutic strategy for a rapid and complete resolution of symptoms. A relay with long-acting somatostatin analogue is probably beneficial despite the negativity of the two recent French trials. Surgery and placement of a nasogastric tube should be avoided. In case of medical treatment failure, a gastrostomy may be discussed according to the prognosis. The management should be multidisciplinary and focus on quality of life.