Maligne intestinale Obstruktion

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
• 2 Krouse R S. Surgical management of malignant bowel obstruction.  Surg Oncol Clin N Am. 2004;  13 (3) 479-490
• 3 Ripamonti C, Bruera E. Palliative management of malignant bowel obstruction.  Int J Gynecol Cancer. 2002;  12 (2) 135-143
• 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
• 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
• 6 Averbach A M, Sugarbaker P H. Recurrent intraabdominal cancer with intestinal obstruction.  Int Surg. 1995;  80 (2) 141-146
• 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
• 8 Ripamonti C I, Easson A M, Gerdes H. Management of malignant bowel obstruction.  Eur J Cancer. 2008;  44 (8) 1105-1115
• 9 Krebs H B, Goplerud D R. Surgical management of bowel obstruction in advanced ovarian carcinoma.  Obstet Gynecol. 1983;  61 (3) 327-330
• 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
• 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
• 12 Spiegel D. Effects of psychotherapy on cancer survival.  Nat Rev Cancer. 2002;  2 (5) 383-389
• 13 Delabrousse E, Destrumelle N, Brunelle S. et al . CT of small bowel obstruction in adults.  Abdom Imaging. 2003;  28 (2) 257-266
• 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
• 15 Furukawa A, Yamasaki M, Furuichi K. et al . Helical CT in the diagnosis of small bowel obstruction.  Radiographics. 2001;  21 (2) 341-355
• 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
• 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
• 18 Tang E, Davis J, Silberman H. Bowel obstruction in cancer patients.  Arch Surg. 1995;  130 (8) 832-836, discussion 836 – 837
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 26 Choi Y B. Laparoscopic gatrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer.  Surg Endosc. 2002;  16 (11) 1620-1626
• 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
• 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
• 29 Kozarek R A. Endoscopic palliation of esophageal malignancy.  Endoscopy. 2003;  35 (8) S9-S13
• 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
• 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
• 32 Baron T H, Harewood G C. Enteral self-expandable stents.  Gastrointest Endosc. 2003;  58 (3) 421-433
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 50 Dua K S. Stents for palliating malignant dysphagia and fistula: is the paradigm shifting?.  Gastrointest Endosc. 2007;  65 (1) 77-81
• 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
• 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
• 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
• 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
• 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
• 56 Espinel J, Sanz O, Vivas S. et al . Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation.  Surg Endosc. 2006;  20 (7) 1083-1087
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 64 Synofzik M. Tube-feeding in advanced dementia. An evidence-based ethical analysis.  Nervenarzt. 2007;  78 (4) 418-428
• 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
• 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
• 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
• 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
• 69 Baron T H, Rey J F, Spinelli P. Expandable metal stent placement for malignant colorectal obstruction.  Endoscopy. 2002;  34 (10) 823-830
• 70 Baron T H. Acute colonic obstruction.  Gastrointest Endosc Clin N Am. 2007;  17 (2) 323-339, vi
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 78 Kaasa S, De Conno F. Palliative care research.  Eur J Cancer. 2001;  37 (Suppl 8) S153-S159
• 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
• 80 Holtmann M H, Siepmann U, Mahlkow S. et al . Gastroenterologische Symptomkontrolle in der Palliativmedizin (Teil 1).  Der Gastroenterologe. 2008;  4 (1) 64-73
• 81 Holtmann M H, Siepmann U, Mahlkow S. et al . Gastroenterologische Symptomkontrolle in der Palliativmedizin (Teil 2).  Der Gastroenterologe. 2009;  4 (2) 147-156
• 82 Relief WHOCP. Geneva; 1996 2nd ed
• 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
• 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
• 85 Meissner W, Schmidt U, Hartmann M. et al . Oral naloxone reverses opioid-associated constipation.  Pain. 2000;  84 (1) 105-109
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 93 Dean A. The palliative effects of octreotide in cancer patients.  Chemotherapy. 2001;  47 (Suppl 2) 54-61
• 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
• 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
• 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
• 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
• 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
• 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
• 100 Burge F I. Dehydration symptoms of palliative care cancer patients.  J Pain Symptom Manage. 1993;  8 (7) 454-464
• 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