Palliation of gastrointestinal obstruction

Article Figures & Data

Table 1

Stent complications

COMPLICATION	FREQUENCY, %
Tumour ingrowth	2
Fistula (rectovesical)	0.8
Bowel perforation (from guide wire, pressure necrosis, balloon dilation, chemotaxis assay)	3.76–5.6
Biliary obstruction	50
Stent migration (post–chemotaxis assay)	3–14
Stent dysfunction (failure to cross stricture, failure to open)	3.8
Bleeding	< 5
Recurrent obstruction	10
Mortality	0–4^9,13

Table 2

Medications for treatment of obstruction

CATEGORY	MEDICATION	DOSAGE
Analgesic drugs	Opioids (SQ or transdermal)	As needed to control symptoms
	Steroids (eg, dexamethasone)	See below
	Antispasmodic-anticholinergics	See below
Antisecretory agents	Dexamethasone	6–20 mg/d SQ trial for 3–5 d
	Octreotide	100–1500 μg/d SQ
	Antispasmodic-anticholinergics
	• Hyoscine butylbromide	40–120 mg/d SQ
	• Glycopyrrolate	0.1–0.4 mg/d SQ
	• Scopolamine	0.2–2 mg/d SQ or 1–2 transdermal patches of 1.5 mg every 3 d
	H₂-receptor antagonists (eg, famotidine, ranitidine)	As needed to control symptoms
	Proton pump inhibitors	As needed to control symptoms
Antiemetic drugs	Metoclopramide (if no colicky pain)	40–240 mg/d SQ
	Haloperidol	5–15 mg/d SQ
	Olanzapine	2.5–20 mg/d SL
	Phenothiazines (sedation)
	• Chlorpromazine	50–100 mg rectally or IM every 8 h
	• Prochlorperazine	25 mg rectally every 8 h
	• Methotrimeprazine	6.25–50 mg/d SQ
	Dimenhydrinate	50–100 mg/d SQ, IV, or rectally
	Ondansetron	4–8 mg twice daily IV
Other	Laxative suppositories, enemas	As needed to control symptoms
Other	Amidotrizoate⁷	A single 50-mL oral dose with metoclopramide, octreotide, dexamethasone SQ in partial obstruction

IM—intramuscularly, IV—intravenously, SL—sublingually, SQ—subcutaneously.
Data from Hanks et al,³ Downing and Wainwright,⁴ Soriano and Davis,⁵ and Glare et al.¹⁴