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Resumen La gastrostomía descompresiva durante los últimos años ha surgido como una alternativa de manejo para la paliación de síntomas en personas con enfermedad oncológica terminal que desarrollan obstrucción intestinal sin indicación quirúrgica inicial y es refractaria al manejo médico. El objetivo es brindar calidad de vida a través de la restauración de la vía oral. Sus contraindicaciones han variado con el tiempo; sin embargo, han surgido nuevas técnicas que permiten ampliar el espectro de indicaciones de este procedimiento. Se ha descrito que permite apoyar el control de síntomas, el retorno de la persona a su lugar de cuidado y, posiblemente, el reinicio de la vía oral con la intención de mantener la calidad de vida de la persona.
Abstract In recent years, decompressive gastrostomy has emerged as a therapeutic option for people with terminal cancer who experience intestinal obstruction without an initial surgical indication and refractory to medical treatment. The objective is to provide a better quality of life by restoring the oral route. Its contraindications have varied over time; however, new techniques have allowed broadening the spectrum of indications for this procedure. It has been reported that this technique supports symptom control and allows the return of the patients to their place of care. It could also allow restarting the oral route in order to maintain quality of life.
Subject(s)
Humans , Female , Middle Aged , Gastrostomy , Intestinal Obstruction , Neoplasms , Patients , Quality of Life , Therapeutics , Contraindications , LiteratureABSTRACT
Objective:To observe the clinical effects of intraperitoneal perfusion of bevacizumab combined with albumin paclitaxel and carboplatin in the treatment of malignant peritoneal adhesion caused by ovarian cancer.Methods:From January 2016 to December 2020, 54 patients treated in our hospital with malignant peritoneal adhesions caused by ovarian cancer were enrolled in this study. They were randomly divided into experimental group ( n=27) and control group ( n=27) according to the random number table method. The treatment regimen of the experimental group was intravenous infusion of albumin paclitaxel plus intraperitoneal infusion of carboplatin and bevacizumab. The treatment regimen of the control group was intra-venous infusion of albumin paclitaxel plus intraperitoneal infusion of carboplatin. The treatment was repeated every 21 days, and the therapeutic effect was evaluated every two cycles. The treatment lasted for six cycles. The efficacy and incidence of adverse reactions were compared between the two groups. Results:The remission rate of incomplete malignant bowel obstruction of the experimental group was higher than that of the control group [85.19% (23/27) vs. 59.26% (16/27)], the total effective rate of the experimental group was higher than that of the control group [74.07% (20/27) vs. 44.44% (12/27)], and there were statistically significant differences ( χ2=4.523, P=0.033; χ2=4.909, P=0.027). After treatment, the levels of vascular endothelial growth factor (VEGF) in ascites of the experimental group and the control group were significantly lower than those before treatment [(80.33±1.41) pg/ml vs. (310.45±3.35) pg/ml, t=449.884, P<0.001; (135.68±1.60) pg/ml vs. (310.46±3.09) pg/ml, t=499.281, P<0.001], and after treatment, the VEGF level in the experimental group decreased more significantly than that in the control group ( t=-134.907, P<0.001). Patients in the experimental group and the control group tolerated the treatment well, and there were no significant differences in the incidences of adverse reactions such as hypertension (11.11% vs. 3.70%, χ2=0.270, P=0.603), neutropenia (14.81% vs. 11.11%, χ2<0.001, P>0.999), peripheral neuropathy (3.70% vs. 0, χ2<0.001, P>0.999), diarrhea (7.41% vs. 3.70%, χ2<0.001, P>0.999), nausea (3.70% vs. 0, χ2<0.001, P>0.999), epistaxis (7.41% vs. 0, χ2=0.519, P=0.471) or albuminuria (3.70% vs. 0, χ2<0.001, P>0.999) between the two groups. Conclusion:Intraperitoneal perfusion of bevacizumab combined with chemotherapy is superior to simple chemotherapy in the treatment of malignant peritoneal adhesion caused by ovarian cancer.
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OBJECTIVE@#To evaluate the efficacy and safety of topical delivery of modified Da-Cheng- Qi Decoction (, MDCQD) by low-frequency ultrasound sonophoresis (LFUS) in patients with refractory metastatic malignant bowel obstruction (MBO) using an objective performance criteria (OPC) design.@*METHODS@#Fifty patients with refractory metastatic MBO were enrolled in this open-label single-arm clinical trial. Alongside fasting, gastrointestinal decompression, glycerol enema, intravenous nutrition and antisecretory therapy, a 50 g dose of MDCQD (prepared as a hydrogel) was applied through topical delivery at the site of abodminal pain or Tianshu (S 25) using LFUS for 30 min, twice daily for 5 consecutive days. The overall outcome was the remission of intestinal obstruction, and improvement on abdominal pain, abdominal distention, nausea and vomiting scores. Indicators of safety evaluation included liver and renal function as well as blood coagulation indicators.@*RESULTS@#Among 50 patients, 5 patients (10%) showed complete remission of intestinal obstruction and 21 patients (42%) showed improvement of intestinal obstruction. The overall remission rate of bowel obstruction was 52%. The results of the symptom score, based on the severity and frequency of the episode, are as follows: 26 patients (52%) showed improvment on symptom scores, 20 patients (40%) did not respond to treatment, and 4 patients (8%) discontinued treatment due to intolerance. No serious adverse effects or abnormal changes on liver and renal function or blood coagulation were observed.@*CONCLUSION@#Topical delivery of MDCQD at 100 g/day using LFUS can improve the treatment response in patients with refractory metastatic MBO.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Administration, Cutaneous , Drugs, Chinese Herbal , Intestinal Neoplasms , Intestinal Obstruction , Drug Therapy , Ultrasonic Therapy , MethodsABSTRACT
OBJECTIVE： To systematically evaluate the efficacy and safety of octreotide combined with conventional therapy in alleviating malignant bowel obstruction （MBO）， and provide evidence-based reference for clinical medication. METHODS： Retrieved from Cochrane Library， PubMed， Embase， CNKI， Wanfang database and Google academic， RCTs about octreotide combined with conventional therapy （trial group） vs. conventional therapy （control group） for relieving MBO were collected. After literature screening， data extraction and quality evaluation with Cochrane system evaluator manual 5.0 risk evaluation tool， Meta-analysis was conducted by using Rev Man 5.3 statistical software. RESULTS： A total of 13 items of RCT were included， with a total of 850 patients. Meta-analysis results showed that total response rate of trial group was significantly higher than control group [OR＝5.30，95％CI（3.47，8.10），P＜0.000 01]. Results of subgroup analysis showed that total response rate of single administration patients [OR＝6.88，95％CI（3.22，4.68），P＜0.000 01] and continuous administration patients [OR＝4.60， 95％CI（2.76，7.68）， P＜0.000 01] in trial group were significantly higher than control group. The abdominal distension relief time [MD＝－3.92， 95％CI（－4.15， －3.70）， P＜0.000 01]， abdominal pain relief time [MD＝－3.37， 95％CI（－3.61，－3.14）， P＜0.000 01]， nausea and vomiting relief time [MD＝－2.46， 95％CI（－2.81，－2.21）， P＜0.000 01] and exhaust relief time [MD＝－2.88， 95％CI（－3.31， －2.46）， P＜0.000 01] in trial group were significantly shorter than control group. Subgroup analysis of exhaust relief time showed that exhaust relief time of single administration patients [MD＝－2.90，95％CI（－3.48，－2.32），P＜0.000 01] and continuous administration patients [MD＝－2.71， 95％CI（－3.14，－2.29）， P＜0.000 01] in trial group were significantly shorter than control group. After treatment， the gastrointestinal decompression volume （P＜0.05） and the incidence of ADR [OR＝0.28，95％CI（0.13，0.62），P＝0.001] in trial group were significantly lower than in control group. CONCLUSIONS： Octreotide combined with conventional treatment is safe and effective in alleviating MBO.
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Gastric cancer is one of the most common types of cancer worldwide. In China, approximately 42%of new cancer cas-es are documented. However, the prognosis of advanced gastric cancer remains poor because of high recurrence and metastatic rates. In gastric cancer patients with peritoneal metastasis, malignant bowel obstruction (MBO) is often detected. Many of these patients endure excruciating pain because of ineffective diagnosis and treatment. In recent years, the symptoms of many patients with MBO have been effectively relieved after somatostatin and other drugs have been administered. Other patients with MBO have been provided the chance to undergo chemotherapy, and their survival time has been prolonged. Hence, the diagnosis and treatment of these patients could be im-proved by further advancements in basic and clinical research in cancer therapy.
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Malignant bowel obstruction (MBO) is common in patients with bowel or gynaecological canc-er. Although surgery is the primary treatment for most patients with MBO, it should not be undertaken rou-finely in patients with poor prognosis. Nasogastric drainage is only a temporary measure. Serf-expanding me-tallic stents are optimistic in malignant obstruction of the gastric outlet and proximal small bowel.
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Percutaneous transesophageal gastro-tubing (PTEG) is considered a safe and effective treatment technique for drainage or feeding in patients with malignant bowel obstruction. We report six cases with malignant bowel obstruction due to recurrent gastric cancer whose bowel symptoms were satisfactory improved with PTEG. Ileus tubes were inserted in three of the six patients for decompression of the alimentary tract, a feeding tube was inserted in one patient for enteral feeding, and double elementary diet tubes (W-ED tube) were inserted in other two for decompression and enteral feeding. The median indwelling duration was 52days (rang; 24-460days). Home enteral nutrition was possible for the three patients with feeding tube and W-ED tube. Regarding decompression of alimentary tract, PTEG relieved the symptoms of all patients. One patient suffered from dermatitis around the inserted part of ileus tube because of the leakage of gastro-intestinal juice, and the ileus tube was removed. In two cases, the inserted tubes were exchanged because of the tube obstruction. PTEG made possible to use various types of tube depending on the state of the disease. From our experience, it is suggested that PTEG technique is an effective and useful procedure of choice for long-term drainage or feeding in patients with malignant bowel obstruction. Palliat Care Res 2008; 3(2): 335-342
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PURPOSE: Malignant bowel obstruction caused by recurrent gastric cancer must be treated appropriately to improve the effects of treatment and to prolong survival. We reviewed the surgical treatments for malignant bowel obstruction caused by recurrent gastric cancer. MATERIALS AND METHODS: The subjects were patients with malignant bowel obstruction caused by recurrent gastric cancer and these patients were treated by surgical procedures at our hospital from 1998 to 2008. The patients were treated by resection, ostomy or bypass. The success of treatment was decided when the patients were able to tolerate more than a liquid diet. RESULTS: 42 patients were treated 46 times by surgical procedures. Resection was done12 times, ostomy was done 24 times and bypass was done 10 times. The hospital stay and the period to liquid diet after the operation were shorter in the ostomy group. The post operative morbidity rate was 21.7% and the post operative death rate was 8.7%. There was no significant difference in survival according to the type of surgery. CONCLUSION: Ostomy is good choice for selected patients because it has a shorter hospital stay and period to liquid diet. There was no significant difference in survival according to the type of surgery because curative resection is difficult to perform in patients with malignant bowel obstruction.