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Systematic review
Inoperable malignant bowel obstruction: palliative interventions outcomes – mixed-methods systematic review
  1. Michael Patterson1,
  2. Sarah Greenley2,
  3. Yangmyung Ma3,
  4. Alex Bullock1,
  5. Jordan Curry1,
  6. Jacquelyn Smithson4,
  7. Michael Lind5 and
  8. Miriam J Johnson1
  1. 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
  2. 2 Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, UK
  3. 3 Department of Plastic Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  4. 4 Gastrointestinal and Liver services, Hull University Teaching Hospitals NHS Trust, Hull, UK
  5. 5 Hull York Medical School, University of Hull, Hull, UK
  1. Correspondence to Michael Patterson, University of Hull, Hull HU6 7RX, UK; michael.patterson{at}hyms.ac.uk

Abstract

Background Parenteral nutrition (PN) and palliative venting gastrostomies (PVG) are two interventions used clinically to manage inoperable malignant bowel obstruction (MBO); however, little is known about their role in clinical and quality-of-life outcomes to inform clinical decision making.

Aim To examine the impact of PN and PVG on clinical and quality-of-life outcomes in inoperable MBO.

Design A mixed-methods systematic review and narrative synthesis.

Data sources The following databases were searched (from inception to 29 April 2021): MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Bielefeld Academic Search Engine, Health Technology Assessment and CareSearch for qualitative or quantitative studies of MBO, and PN or PVG. Titles, abstracts and papers were independently screened and quality appraised.

Results A total of 47 studies representing 3538 participants were included. Current evidence cannot tell us whether these interventions improve MBO survival, but this was a firm belief by patients and clinicians informing their decision. Both interventions appear to allow patients valuable time at home. PVG provides relief from nausea and vomiting. Both interventions improve quality of life but not without significant burdens. Nutritional and performance status may be maintained or improved with PN.

Conclusion PN and PVG seem to allow valuable time at home. We found no conclusive evidence to show either intervention prolonged survival, due to the lack of randomised controlled trials that have to date not been performed due to concerns about equipoise. Well-designed studies regarding survival for both interventions are needed.

PROSPERO registration number CRD42020164170.

  • Intestinal obstruction
  • Gastrointestinal (lower)
  • Genitourinary
  • Quality of life
  • Gastrointestinal (upper)
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjspcare-2021-003492

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    Footnotes

    • Twitter @MPattersonRD, @MJJohnson_HYMS

    • Contributors MP and MJJ designed the project. MP, SG and MJJ designed the protocol. MP and SG conducted the literature search. MP, YM, AB and JC performed the screening and quality assessment. MP, YM and AB performed the data extraction. MP and AB performed the analysis. MP drafted the initial manuscript. MP and MJJ have overall responsibility for the final content. MP is guarantor.

    • Funding This work was funded by Yorkshire Cancer Research (Award reference number HEND405PhD). Publication costs will be provided by Yorkshire Cancer Research TRANSFORM programme.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.