Role of octreotide, scopolamine butylbromide, and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: Aprospective randomized trial

Bowel obstruction may be an inoperable complication in patients with end-st age cancer. Scopolamine butylbromide (SB) and octreotide (OCT) have been su ccessfully used with the aim of reducing gastrointestinal (GI) secretions t o avoid placement of a nasogastric tube (NGT); however, there have been no comparative studies concerning the efficacy of these drugs. Furthermore, th ere is little information about the role played by parenteral hydration in symptom control of these patients. In a prospective trial that involved all 17 inoperable bowel-obstructed patients presenting to our services with a decompressive NGT, patients were randomized to OCT 0.3 mg/day or SB 60 mg/d ay for 3 days through a continuous subcutaneous infusion. Clinical data, su rvival time, and the time interval from the first diagnosis of cancer to th e onset of inoperable bowel obstruction were noted. The intensity of pain, nausea, dry mouth, thirst, dyspnea, feeling of abdominal distension, and dr owsiness were assessed by means of a verbal scale before starting treatment with the drugs under study (T0) and then daily for 3 days (T1, T2, T3). Mo reover, daily information was collected regarding the quantity of GI secret ions through the NGT, the oral intake of fluids, the quantity of parenteral hydration, and the analgesic therapy used. The NGT could be removed in all 10 home care and in 3 hospitalized patients without changing the dosage of the drugs. OCT significantly reduced the amount of GI secretions at T2 (P = 0.016) and T3 (P = 0.020). Compared to the home care patients, the hospit alized patients received significantly more parenteral hydration (P = 0.000 5) and drank more fluids (P = 0.025). There was no difference in the daily thirst and dry mouth intensity in relation to the amount of parenteral hydr ation or the treatment provided (OCT or SB). Independent of antisecretory t reatment, the patients receiving less parenteral hydration presented signif icantly more nausea (T0 P = 0.002; T1 P = 0.001; T2 P = 0.003; T3 P = 0.001 ) and drowsiness at T3 (P < = 0.05). Pain relief was obtained in all 17 pat ients and only two patients required an increase in the morphine dose at T1 . All patients and only two patients required an increase in the morphine d ose at T1. All patients with inoperable malignant bowel obstruction should undergo treatment with antisecretory drugs so as to evaluate the possibilit y of removing the NGT. When a more rapid reduction in GI secretions is desi red, OCT should be considered as the first choice drug. Parenteral hydratio n over 500 ml/day may reduce nausea and drowsiness. (C) U.S. Cancer Pain Re lief Committee, 2000.