Palliative medical management of inoperable malignant bowel obstruction with “triple therapy”: Dexamethasone, octreotide, and metoclopramide at a comprehensive cancer center.

Abstract

125 Background: Malignant bowel obstruction (MBO) is a complication of advanced malignancy. For inoperable patients, symptoms are often treated using analgesics, anticholinergics, and anti-emetics. There are, however, few published guidelines or algorithms for the medical management of MBO. Therefore, the objective was to measure the effect of the combination of dexamethasone, octreotide, and metoclopramide (“triple therapy”) in patients with MBO, compared to patients who received none of the three medications (“no drug therapy”). Methods: A retrospective cohort study was done of patients with malignant bowel obstruction admitted between 1/1/2015 to 12/31/2018. The outcome measures were a patient having de-obstruction (defined as toleration of oral intake and resolution of nausea and vomiting), as well as time to de-obstruction. Results: Medical staff identified 34 patients who received triple therapy and 34 patients who received no drug therapy. Patients who received triple therapy were more likely to reach de-obstruction, compared to patients who had no drug therapy (OR: 9.02 [1.43, 56.99], p=0.0194), after adjusting for related covariates (i.e. length of stay and percutaneous endoscopic gastrostomy [PEG] placement). Patients who reached de-obstruction in the triple therapy arm, however, took longer to reach de-obstruction than those in the no drug therapy arm (5.4 days versus 3.4 days, p=0.045). Conclusions: Triple drug therapy with dexamethasone, octreotide, and metoclopramide leads to higher rates of de-obstruction in patients with inoperable MBO, compared to patients who received none of the three drugs, though time to de-obstruction is longer.