The role of parenteral nutrition in patients with malignant bowel obstruction

Abstract

Purpose: The role of parenteral nutrition in the treatment of malignant bowel obstruction is underestimated since palliative literature mainly focuses on gastric aspiration, nothing per os and antisecretory therapy. The purpose of this review is the appraisal of the literature with a focus on the potential contribution of parenteral nutrition. Methods: Literature included in a recent meta-analysis and in a Cochrane review on parenteral nutrition in malignant bowel obstruction and updated through PUBMED until March 2019 has been reviewed. Results: Prompt withholding of food intake, nasogastric aspiration and then the use of antisecretory agents represent the milestones of treatment which are applied to all patients with malignant bowel obstruction. After this initial approach, excluding few surgical patients and those defined as imminently dying, there is a heterogeneous group of patients achieving a benefit in a few days but with a prompt recurrence of symptoms as they attempt to reassume some food intake. Parenteral nutrition in hospital or at home addresses to these patients provided their life expectancy is likely to depend on progressive nutritional deterioration due to the prolonged starvation more than on the tumour spread. These patients on home parenteral nutrition can survive a few months with some indefinite benefit on quality of life whereas untreated patients have a survival of few weeks. Conclusion: Parenteral nutrition should be considered in selected patients who benefit from standard palliative treatment of malignant obstruction and are obliged to maintain a total bowel rest for weeks or months.