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Z Gastroenterol 2010; 48(2): 264-273
DOI: 10.1055/s-0028-1109774
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Maligne intestinale Obstruktion

Malignant Bowel ObstructionM. Zorn1 , D. Domagk2 , T. Auerbauch3 , J. Mais4 , T. Brauckhoff5 , M. H. Holtmann1
  • 1Medizinische Klinik I (Schwerpunkte Gastroenterologie, Stoffwechsel, Infektiologie, Onkologie und Palliativmedizin), St.-Vincenz-Krankenhaus, Datteln
  • 2Medizinische Klinik und Poliklinik B, Westfälische Wilhelms-Universität, Münster
  • 3Radiologische Klinik, Johannes-Gutenberg-Universität, Mainz
  • 4Abteilung für Radiologie, St.-Vincenz-Krankenhaus, Datteln
  • 5Abteilung für Allgemein- und Viszeralchirurgie, St.-Vincenz-Krankenhaus, Datteln
Weitere Informationen

Publikationsverlauf

Manuskript eingetroffen: 7.4.2009

Manuskript akzeptiert: 1.9.2009

Publikationsdatum:
02. Februar 2010 (online)

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Zusammenfassung

Die maligne intestinale Obstruktion (MIO) ist eine häufige Komplikation bei Patienten mit maligner Grunderkrankung und stellt eine der größten interdisziplinären diagnostischen und therapeutischen Herausforderungen in der Palliativmedizin dar. Die Gastroenterologie spielt hierbei eine zentrale Rolle. Nach der diagnostischen Einordnung ist es wichtig, mit dem Patienten und den Angehörigen adäquate Therapieziele festzulegen, die in der Regel symptomorientiert sind. Therapeutisch stehen grundsätzlich chirurgische, endoskopische oder konservativ-medikamentöse Maßnahmen zur Verfügung. Diese sollen anhand von Fallbeispielen vorgestellt werden. Die MIO wird in der internationalen Literatur zunehmend als eigenständige Entität behandelt. Anliegen dieses Beitrags ist es, die MIO in der deutschsprachigen Literatur als solche zu vermitteln.

Abstract

Malignant bowel obstruction (MBO) is a frequent complication in patients with a progressive malignant disorder and represents a major interdisciplinary challenge in palliative care. Gastroenterology plays a pivotal role in the management of MBO. After appropriate diagnostic work-up, it is important to define treatment goals with the patient and his/her relatives, which should focus on symptom relief. Therapeutically, surgical, endoscopic and medical options are available. These will be introduced based on case reports. In the international literature MBO is being more and more considered as a distinct entity. The aim of the present review is to communicate MBO as such in the German medical literature.

Schlüsselwörter

kolorektales Karzinom - Malassimilation - Magenkarzinom - Ösophaguskarzinom - Palliativmedizin - maligne intestinale Obstruktion

Key words

colorectal cancer - malassimilation - stomach cancer - oesophageal carcinoma - palliative medicine - malignant bowel obstruction

Literatur

  • 1 Holtmann M H, Domagk D, Weber M. et al . Gastroenterological palliative care.  Z Gastroenterol. 2007;  46 (7) 712-724
    Google Scholar
  • 2 Krouse R S. Surgical management of malignant bowel obstruction.  Surg Oncol Clin N Am. 2004;  13 (3) 479-490
    Google Scholar
  • 3 Ripamonti C, Bruera E. Palliative management of malignant bowel obstruction.  Int J Gynecol Cancer. 2002;  12 (2) 135-143
    Google Scholar
  • 4 Anthony T, Baron T, Mercadante S. et al . Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction.  J Pain Symptom Manage. 2007;  34 (1 Suppl) S49-S59
    Google Scholar
  • 5 Aabo K, Pedersen H, Bach F. et al . Surgical management of intestinal obstruction in the late course of malignant disease.  Acta Chir Scand. 1984;  150 (2) 173-176
    Google Scholar
  • 6 Averbach A M, Sugarbaker P H. Recurrent intraabdominal cancer with intestinal obstruction.  Int Surg. 1995;  80 (2) 141-146
    Google Scholar
  • 7 Baines M. The pathophysiology and management of malignant bowel obstruction. Doyle D, Hanks G, MacDonald N Oxford textbook of palliative medicine Oxford; Oxford University Press 1998: 526-534
    Google Scholar
  • 8 Ripamonti C I, Easson A M, Gerdes H. Management of malignant bowel obstruction.  Eur J Cancer. 2008;  44 (8) 1105-1115
    Google Scholar
  • 9 Krebs H B, Goplerud D R. Surgical management of bowel obstruction in advanced ovarian carcinoma.  Obstet Gynecol. 1983;  61 (3) 327-330
    Google Scholar
  • 10 Kaasa S, Hjermstad M J, Loge J H. Methodological and structural challenges in palliative care research: how have we fared in the last decades?.  Palliat Med. 2006;  20 (8) 727-734
    Google Scholar
  • 11 Easson A M, Lee K F, Brasel K. et al . Clinical research for surgeons in palliative care: challenges and opportunities.  J Am Coll Surg. 2003;  196 (1) 141-151
    Google Scholar
  • 12 Spiegel D. Effects of psychotherapy on cancer survival.  Nat Rev Cancer. 2002;  2 (5) 383-389
    Google Scholar
  • 13 Delabrousse E, Destrumelle N, Brunelle S. et al . CT of small bowel obstruction in adults.  Abdom Imaging. 2003;  28 (2) 257-266
    Google Scholar
  • 14 DiSantis D J, Ralls P W, Balfe D M. et al . The patient with suspected small bowel obstruction: imaging strategies. American College of Radiology. ACR Appropriateness Criteria.  Radiology. 2000;  215 (Suppl) 121-124
    Google Scholar
  • 15 Furukawa A, Yamasaki M, Furuichi K. et al . Helical CT in the diagnosis of small bowel obstruction.  Radiographics. 2001;  21 (2) 341-355
    Google Scholar
  • 16 Chung C C, Meng W C, Yu S C. et al . A prospective study on the use of water-soluble contrast follow-through radiology in the management of small bowel obstruction.  Aust N Z J Surg. 1996;  66 (9) 598-601
    Google Scholar
  • 17 Ericksen A S, Krasna M J, Mast B A. et al . Use of gastrointestinal contrast studies in obstruction of the small and large bowel.  Dis Colon Rectum. 1990;  33 (1) 56-64
    Google Scholar
  • 18 Tang E, Davis J, Silberman H. Bowel obstruction in cancer patients.  Arch Surg. 1995;  130 (8) 832-836, discussion 836 – 837
    Google Scholar
  • 19 Legendre H, Vanhuyse F, Caroli-Bosc F X. et al . Survival and quality of life after palliative surgery for neoplastic gastrointestinal obstruction.  Eur J Surg Oncol. 2001;  27 (4) 364-367
    Google Scholar
  • 20 Makela J, Kiviniemi H, Laitinen S. et al . Surgical management of intestinal obstruction after treatment for cancer. Case reports.  Eur J Surg. 1991;  157 (1) 73-77
    Google Scholar
  • 21 Feuer D J, Broadley K E, Shepherd J H. et al . Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer.  Cochrane Database Syst Rev. 2000;  4 CD002764
    Google Scholar
  • 22 Yazdi G P, Miedema B W, Humphrey L J. High mortality after abdominal operation in patients with large-volume malignant ascites.  J Surg Oncol. 1996;  62 (2) 93-96
    Google Scholar
  • 23 Blair S L, Chu D Z, Schwarz R E. Outcome of palliative operations for malignant bowel obstruction in patients with peritoneal carcinomatosis from nongynecological cancer.  Ann Surg Oncol. 2001;  8 (8) 632-637
    Google Scholar
  • 24 Higashi H, Shida H, Ban K. et al . Factors affecting successful palliative surgery for malignant bowel obstruction due to peritoneal dissemination from colorectal cancer.  Jpn J Clin Oncol. 2003;  33 (7) 357-359
    Google Scholar
  • 25 Isla A M, Worthington T, Kakkar A K. et al . A continuing role for surgical bypass in the palliative treatment of pancreatic carcinoma.  Dig Surg. 2000;  17 (2) 143-146
    Google Scholar
  • 26 Choi Y B. Laparoscopic gatrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer.  Surg Endosc. 2002;  16 (11) 1620-1626
    Google Scholar
  • 27 Ripamonti C, Twycross R, Baines M. et al . Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer.  Support Care Cancer. 2001;  9 (4) 223-233
    Google Scholar
  • 28 Ooijen van B, Burg M E, Planting A S. et al . Surgical treatment or gastric drainage only for intestinal obstruction in patients with carcinoma of the ovary or peritoneal carcinomatosis of other origin.  Surg Gynecol Obstet. 1993;  176 (5) 469-474
    Google Scholar
  • 29 Kozarek R A. Endoscopic palliation of esophageal malignancy.  Endoscopy. 2003;  35 (8) S9-S13
    Google Scholar
  • 30 Domschke van der W, Foerster E C, Matek W. et al . Self-expanding mesh stent for esophageal cancer stenosis.  Endoscopy. 1990;  22 (3) 134-136
    Google Scholar
  • 31 Baron T H. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract.  N Engl J Med. 2001;  344 (22) 1681-1687
    Google Scholar
  • 32 Baron T H, Harewood G C. Enteral self-expandable stents.  Gastrointest Endosc. 2003;  58 (3) 421-433
    Google Scholar
  • 33 Lowe A S, Beckett C G, Jowett S. et al . Self-expandable metal stent placement for the palliation of malignant gastroduodenal obstruction: experience in a large, single, UK centre.  Clin Radiol. 2007;  62 (8) 738-744
    Google Scholar
  • 34 Telford J J, Carr-Locke D L, Baron T H. et al . Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study.  Gastrointest Endosc. 2004;  60 (6) 916-920
    Google Scholar
  • 35 Nassif T, Prat F, Meduri B. et al . Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study.  Endoscopy. 2003;  35 (6) 483-489
    Google Scholar
  • 36 Law W L, Choi H K, Lee Y M. et al . Palliation for advanced malignant colorectal obstruction by self-expanding metallic stents: prospective evaluation of outcomes.  Dis Colon Rectum. 2004;  47 (1) 39-43
    Google Scholar
  • 37 Camunez F, Echenagusia A, Simo G. et al . Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation.  Radiology. 2000;  216 (2) 492-497
    Google Scholar
  • 38 Sibille A, Lambert R, Souquet J C. et al . Long-term survival after photodynamic therapy for esophageal cancer.  Gastroenterology. 1995;  108 (2) 337-344
    Google Scholar
  • 39 Barr H, Kendall C, Stone N. Photodynamic therapy for esophageal cancer: a useful and realistic option.  Technol Cancer Res Treat. 2003;  2 (1) 65-76
    Google Scholar
  • 40 Knyrim K, Wagner H J, Bethge N. et al . A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer.  N Engl J Med. 1993;  329 (18) 1302-1307
    Google Scholar
  • 41 Neuhaus H, Hoffmann W, Dittler H J. et al . Implantation of self-expanding esophageal metal stents for palliation of malignant dysphagia.  Endoscopy. 1992;  24 (5) 405-410
    Google Scholar
  • 42 Adam A, Ellul J, Watkinson A F. et al . Palliation of inoperable esophageal carcinoma: a prospective randomized trial of laser therapy and stent placement.  Radiology. 1997;  202 (2) 344-348
    Google Scholar
  • 43 Dallal H J, Smith G D, Grieve D C. et al . A randomized trial of thermal ablative therapy versus expandable metal stents in the palliative treatment of patients with esophageal carcinoma.  Gastrointest Endosc. 2001;  54 (5) 549-557
    Google Scholar
  • 44 Siersema P D, Hop W C, Blankenstein van M. et al . A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study.  Gastrointest Endosc. 2001;  54 (2) 145-153
    Google Scholar
  • 45 Morgan R A, Ellul J P, Denton E R. et al . Malignant esophageal fistulas and perforations: management with plastic-covered metallic endoprostheses.  Radiology. 1997;  204 (2) 527-532
    Google Scholar
  • 46 Dua K S, Kozarek R, Kim J. et al . Self-expanding metal esophageal stent with anti-reflux mechanism.  Gastrointest Endosc. 2001;  53 (6) 603-613
    Google Scholar
  • 47 Wenger U, Johnsson E, Arnelo U. et al . An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study.  Surg Endosc. 2006;  20 (11) 1675-1680
    Google Scholar
  • 48 Shim C S, Jung I S, Cheon Y K. et al . Management of malignant stricture of the esophagogastric junction with a newly designed self-expanding metal stent with an antireflux mechanism.  Endoscopy. 2005;  37 (4) 335-339
    Google Scholar
  • 49 Kinsman K J, DeGregorio B T, Katon R M. et al . Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy.  Gastrointest Endosc. 1996;  43 (3) 196-203
    Google Scholar
  • 50 Dua K S. Stents for palliating malignant dysphagia and fistula: is the paradigm shifting?.  Gastrointest Endosc. 2007;  65 (1) 77-81
    Google Scholar
  • 51 Dormann A, Meisner S, Verin N. et al . Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness.  Endoscopy. 2004;  36 (6) 543-550
    Google Scholar
  • 52 Yim H B, Jacobson B C, Saltzman J R. et al . Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction.  Gastrointest Endosc. 2001;  53 (3) 329-332
    Google Scholar
  • 53 Feretis C, Benakis P, Dimopoulos C. et al . Palliation of malignant gastric outlet obstruction with self-expanding metal stents.  Endoscopy. 1996;  28 (2) 225-228
    Google Scholar
  • 54 Graber I, Dumas R, Filoche B. et al . The efficacy and safety of duodenal stenting: a prospective multicenter study.  Endoscopy. 2007;  39 (9) 784-787
    Google Scholar
  • 55 Seo E H, Jung M K, Park M J. et al . Covered expandable nitinol stents for malignant gastroduodenal obstructions.  J Gastroenterol Hepatol. 2008;  23 1056-1062
    Google Scholar
  • 56 Espinel J, Sanz O, Vivas S. et al . Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation.  Surg Endosc. 2006;  20 (7) 1083-1087
    Google Scholar
  • 57 Jeurnink S M, Steyerberg E W, Hof G. et al . Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients.  J Surg Oncol. 2007;  96 (5) 389-396
    Google Scholar
  • 58 Wong Y T, Brams D M, Munson L. et al . Gastric outlet obstruction secondary to pancreatic cancer: surgical vs. endoscopic palliation.  Surg Endosc. 2002;  16 (2) 310-312
    Google Scholar
  • 59 Schiefke I, Zabel-Langhennig A, Wiedmann M. et al . Self-expandable metallic stents for malignant duodenal obstruction caused by biliary tract cancer.  Gastrointest Endosc. 2003;  58 (2) 213-219
    Google Scholar
  • 60 Mutignani M, Tringali A, Shah S G. et al . Combined endoscopic stent insertion in malignant biliary and duodenal obstruction.  Endoscopy. 2007;  39 (5) 440-447
    Google Scholar
  • 61 Maire F, Hammel P, Ponsot P. et al . Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas.  Am J Gastroenterol. 2006;  101 (4) 735-742
    Google Scholar
  • 62 Mehta S, Hindmarsh A, Cheong E. et al . Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction.  Surg Endosc. 2006;  20 (2) 239-242
    Google Scholar
  • 63 Rabeneck L, McCullough L B, Wray N P. Ethically justified, clinically comprehensive guidelines for percutaneous endoscopic gastrostomy tube placement.  Lancet. 1997;  349 (9050) 496-498
    Google Scholar
  • 64 Synofzik M. Tube-feeding in advanced dementia. An evidence-based ethical analysis.  Nervenarzt. 2007;  78 (4) 418-428
    Google Scholar
  • 65 Campagnutta E, Cannizzaro R, Gallo A. et al . Palliative treatment of upper intestinal obstruction by gynecological malignancy: the usefulness of percutaneous endoscopic gastrostomy.  Gynecol Oncol. 1996;  62 (1) 103-105
    Google Scholar
  • 66 Pothuri B, Montemarano M, Gerardi M. et al . Percutaneous endoscopic gastrostomy tube placement in patients with malignant bowel obstruction due to ovarian carcinoma.  Gynecol Oncol. 2005;  96 (2) 330-334
    Google Scholar
  • 67 Law W L, Choi H K, Chu K W. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer.  Br J Surg. 2003;  90 (11) 1429-1433
    Google Scholar
  • 68 Fregonese D, Naspetti R, Ferrer S. et al . Ultraflex precision colonic stent placement as a bridge to surgery in patients with malignant colon obstruction.  Gastrointest Endosc. 2008;  67 (1) 68-73
    Google Scholar
  • 69 Baron T H, Rey J F, Spinelli P. Expandable metal stent placement for malignant colorectal obstruction.  Endoscopy. 2002;  34 (10) 823-830
    Google Scholar
  • 70 Baron T H. Acute colonic obstruction.  Gastrointest Endosc Clin N Am. 2007;  17 (2) 323-339, vi
    Google Scholar
  • 71 Caceres A, Zhou Q, Iasonos A. et al . Colorectal stents for palliation of large-bowel obstructions in recurrent gynecologic cancer: an updated series.  Gynecol Oncol. 2008;  108 (3) 482-485
    Google Scholar
  • 72 Khot U P, Lang A W, Murali K. et al . Systematic review of the efficacy and safety of colorectal stents.  Br J Surg. 2002;  89 (9) 1096-1102
    Google Scholar
  • 73 Repici A, Fregonese D, Costamagna G. et al . Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study.  Gastrointest Endosc. 2007;  66 (5) 920-927
    Google Scholar
  • 74 Karoui M, Charachon A, Delbaldo C. et al . Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration.  Arch Surg. 2007;  142 (7) 619-623, discussion 623
    Google Scholar
  • 75 Ramadori G, Lindhorst A, Armbrust T. Colorectal tumors with complete obstruction – endoscopic recovery of passage replacing emergency surgery? A report of two cases.  BMC Gastroenterol. 2007;  7 14
    Google Scholar
  • 76 Baumhoer D, Armbrust T, Ramadori G. Nonsurgical treatment of the primary tumor in four consecutive cases of metastasized colorectal carcinoma.  Endoscopy. 2005;  37 (12) 1232-1236
    Google Scholar
  • 77 Armbrust T, Sobotta M, Füzesi L. et al . Chemotherapie-induced suppression to adenoma or complete suppression of the primary in patients with stage IV colorectal cancer: report of four cases.  European Journal of Gastroenterology & Hepatology. 2007;  19 (11) 988-994
    Google Scholar
  • 78 Kaasa S, De Conno F. Palliative care research.  Eur J Cancer. 2001;  37 (Suppl 8) S153-S159
    Google Scholar
  • 79 Baines M, Oliver D J, Carter R L. Medical management of intestinal obstruction in patients with advanced malignant disease. A clinical and pathological study.  Lancet. 1985;  2 (8462) 990-993
    Google Scholar
  • 80 Holtmann M H, Siepmann U, Mahlkow S. et al . Gastroenterologische Symptomkontrolle in der Palliativmedizin (Teil 1).  Der Gastroenterologe. 2008;  4 (1) 64-73
    Google Scholar
  • 81 Holtmann M H, Siepmann U, Mahlkow S. et al . Gastroenterologische Symptomkontrolle in der Palliativmedizin (Teil 2).  Der Gastroenterologe. 2009;  4 (2) 147-156
    Google Scholar
  • 82 Relief WHOCP. Geneva; 1996 2nd ed
    Google Scholar
  • 83 Mercadante S, Porzio G, Ferrera P. et al . Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management.  Eur J Pain. 2008;  12 (8) 1040-1046
    Google Scholar
  • 84 Hanks G W, Conno F, Cherny N. et al . Morphine and alternative opioids in cancer pain: the EAPC recommendations.  Br J Cancer. 2001;  84 (5) 587-593
    Google Scholar
  • 85 Meissner W, Schmidt U, Hartmann M. et al . Oral naloxone reverses opioid-associated constipation.  Pain. 2000;  84 (1) 105-109
    Google Scholar
  • 86 Thomas J, Karver S, Cooney G A. et al . Methylnaltrexone for opioid-induced constipation in advanced illness.  N Engl J Med. 2008;  358 (22) 2332-2343
    Google Scholar
  • 87 Glare P, Pereira G, Kristjanson L J. et al . Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer.  Support Care Cancer. 2004;  12 (6) 432-440
    Google Scholar
  • 88 Critchley P, Plach N, Grantham M. et al . Efficacy of haloperidol in the treatment of nausea and vomiting in the palliative patient: a systematic review.  J Pain Symptom Manage. 2001;  22 (2) 631-634
    Google Scholar
  • 89 Feuer D J, Broadley K E. Systematic review and meta-analysis of corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancers. Systematic Review Steering Committee.  Ann Oncol. 1999;  10 (9) 1035-1041
    Google Scholar
  • 90 Philip J, Lickiss N, Grant P T. et al . Corticosteroids in the management of bowel obstruction on a gynecological oncology unit.  Gynecol Oncol. 1999;  74 (1) 68-73
    Google Scholar
  • 91 Ripamonti C, Panzeri C, Groff L. et al . The role of somatostatin and octreotide in bowel obstruction: pre-clinical and clinical results.  Tumori. 2001;  87 (1) 1-9
    Google Scholar
  • 92 Anthone G J, Bastidas J A, Orandle M S. et al . Direct proabsorptive effect of octreotide on ionic transport in the small intestine.  Surgery. 1990;  108 (6) 1136-1141, discussion 1141 – 1142
    Google Scholar
  • 93 Dean A. The palliative effects of octreotide in cancer patients.  Chemotherapy. 2001;  47 (Suppl 2) 54-61
    Google Scholar
  • 94 Bastounis E, Hadjinikolaou L, Ioannou N. et al . Somatostatin as adjuvant therapy in the management of obstructive ileus.  Hepatogastroenterology. 1989;  36 (6) 538-539
    Google Scholar
  • 95 Ripamonti C, Mercadante S, Groff L. et al . Role of octreotide, scopolamine butylbromide, and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: a prospective randomized trial.  J Pain Symptom Manage. 2000;  19 (1) 23-34
    Google Scholar
  • 96 Mangili G, Franchi M, Mariani A. et al . Octreotide in the management of bowel obstruction in terminal ovarian cancer.  Gynecol Oncol. 1996;  61 (3) 345-348
    Google Scholar
  • 97 Mercadante S, Spoldi E, Caraceni A. et al . Octreotide in relieving gastrointestinal symptoms due to bowel obstruction.  Palliat Med. 1993;  7 (4) 295-299
    Google Scholar
  • 98 Mercadante S, Ripamonti C, Casuccio A. et al . Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction.  Support Care Cancer. 2000;  8 (3) 188-191
    Google Scholar
  • 99 Cozzaglio L, Balzola F, Cosentino F. et al . Outcome of cancer patients receiving home parenteral nutrition. Italian Society of Parenteral and Enteral Nutrition (S. I. N. P.E.).  JPEN J Parenter Enteral Nutr. 1997;  21 (6) 339-342
    Google Scholar
  • 100 Burge F I. Dehydration symptoms of palliative care cancer patients.  J Pain Symptom Manage. 1993;  8 (7) 454-464
    Google Scholar
  • 101 Hoda D, Jatoi A, Burnes J. et al . Should patients with advanced, incurable cancers ever be sent home with total parenteral nutrition? A single institution’s 20-year experience.  Cancer. 2005;  103 (4) 863-868
    Google Scholar

PD Dr. Martin H. Holtmann

Medizinische Klinik I, St. Vincenz-Krankenhaus

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