Scholarlink

Background <p>Malignant gastrointestinal obstruction (MGIO), a frequent complication of peritoneal surface malignancies (PSM), often portends a poor prognosis. The lack of high-quality evidence on optimal management strategies necessitated a national consensus to address this clinical problem.</p> Methods <p>A clinical management pathway was designed through a Delphi consensus process with national experts in peritoneal disease. Two rounds of voting were conducted to assess agreement levels with pathway blocks. Supporting evidence regarding procedural interventions for MGIO underwent evaluation via a rapid literature review.</p> Results <p>Of 111 participants responding in the first round, 90 (81%) responded in the second round. Over 90% consensus was achieved in 4/6 and 6/6 pathway blocks during rounds I and II, respectively. Encouraging a multidisciplinary approach, the pathway emphasized early palliative care assessments and iterative goals of care evaluation throughout treatment. Management was delineated on the basis of obstruction acuity, and selection criteria for palliative-intent surgical interventions and stenting were elucidated. Studies demonstrated limited benefits for such interventions in patients with multifocal obstructions, poor performance status, and high-grade and/or high-burden PSMs. In these cases, a recommendation for supportive care or upper GI decompression tube placement was favored. The overall level of evidence was generally low–moderate in existing literature.</p> Conclusions <p>Given limited evidence, the consensus-driven pathway provides crucial clinical guidance for practitioners dealing with MGIO in patients with PSM. There is a need for high-quality prospective evidence in this domain.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

  • 期刊论文

  • 发表日期：

    2025年6月25日

查看全文
  • Varun V. Bansal,
  • Elizabeth L. Godfrey,
  • Javid Sadjadi,
  • Ricardo J. Bello,
  • Riom Kwakman,
  • Andres A. Abreu,
  • Vignesh Vudatha,
  • Brian K. Sparkman,
  • Devon C. Freudenberger,
  • David G. Su,
  • Kiran K. Turaga,
  • Dejan Micic,
  • Monica Malec,
  • Sandy Tun,
  • Blasé Polite,
  • Laura A. Lambert,
  • Alissa Greenbaum,
  • Craig G. Gunderson,
  • Thomas J. Smith,
  • Kimberly E. Kopecky,
  • Benjamin D. Powers,
  • Ugwuji N. Maduekwe,
  • Erin P. Ward,
  • Abhineet Uppal,
  • Ahmed Hamed,
  • Alda Tam,
  • Alex Fisher,
  • Alex C. Kim,
  • Alexander Loftus,
  • Alexander S. Thomas,
  • Alexandra Gangi,
  • Alicia Greene,
  • Amanda Arrington,
  • Anai Kothari,
  • Anand Govindarajan,
  • Andreana N. Holowatyj,
  • Andrei Nikiforchin,
  • Andrew Łowy,
  • Andrew M Bellizzi,
  • Ankit Dhiman,
  • Anthony Villano,
  • Antoine Bouchard-Fortier,
  • Anwaar Saeed,
  • Armando Sardi,
  • Ashley Efrain Alarcon Rozas,
  • Avinoam Nevler,
  • Baylee Bakkila,
  • Beatrice Sun,
  • Benjamin Powers,
  • Beth Helmink,
  • Biren Reddy,
  • Bradley White,
  • Brian Badgwell,
  • Byrne Lee,
  • Caitlin Hester,
  • Carla Harmath,
  • Carlos Chan,
  • Carrie Luu,
  • Catalina Mosquera,
  • Charles Staley,
  • Chukwuemeka Ihemelandu,
  • Colette Brottman,
  • Colette Pameijer,
  • Colin Court,
  • Conor O’Neill,
  • Dan Blazer,
  • Daniel Labow,
  • Daniel Milgrom,
  • Daniel Tuvin,
  • Darryl Outlaw,
  • Darryl Schuitevoerder,
  • David Bartlett,
  • David Bentrem,
  • David Hanna,
  • Deepa Magge,
  • Deyali Chatterjee,
  • Diane Reidy-Lagunes,
  • Divya Sood,
  • Edward Levine,
  • Ekaterina Baron,
  • Elizabeth Olecki,
  • Emily Papai,
  • Emmanuel Gabriel,
  • Eric Pletcher,
  • Fabian Johnston,
  • Fadi Dahdaleh,
  • Farin Amersi,
  • Felipe Lopez-Ramirez,
  • Forest Mahoney,
  • Francisco Izquierdo,
  • Frederick A. Godley,
  • Garrett Nash,
  • Gary N. Mann,
  • George Salti,
  • Georgios Georgakis,
  • Georgios Karagkounis,
  • Gilbert Murimwa,
  • Giorgos Karakousis,
  • Hallbera Gudmundsdottir,
  • Hanlin L. Wang,
  • Hanna Sanoff,
  • Harveshp Mogal,
  • Hunter Witmer,
  • Ioannis Konstantinidis,
  • Ira L. Leeds,
  • Jackson Baril,
  • Jacquelyne J. Gaddy,
  • James Cusack Campbell Jr,
  • James W Fleshman,
  • Jane Wang,
  • Jason M Foster,
  • Jeff Sussman,
  • Jeffrey M. Sutton,
  • Jennifer Keller,
  • Jeremy Davis,
  • Jesus Esquivel,
  • Jig Deneve,
  • Joanna Buchheit,
  • Joel Baumgartner,
  • John Kunstman,
  • John Paul Shen,
  • Jonathan B. Greer,
  • Jorge L. Gomez,
  • Jose M. Pimiento,
  • Joshua Winer,
  • Jula Veerapong,
  • Jun Gong,
  • Katherine Hill,
  • Katrina S. Pedersen,
  • Kevin Sullivan,
  • Kimberly Johung,
  • Konstantinos Chouliaras,
  • Kostas Votanopoulos,
  • Kristina A. Matkowskyj,
  • Kurt S. Schultz,
  • Lauren Raymond,
  • Lauren Schleimer,
  • Leanne M. Brown,
  • Leonard Saltz,
  • Leopoldo Fernandez,
  • Lindy Davis,
  • Lloyd Mack,
  • MTalha Waheed,
  • Madeline B. Torres,
  • Maheswari Senthil,
  • Marcello Deraco,
  • Marcovalerio Melis,
  • Maria Russell,
  • Marie Robert,
  • Mary Garland-Kledzik,
  • Mason Vierra,
  • Mazin Al-Kasspooles,
  • Mecker Moller,
  • Mehraneh D Jafari,
  • Melanie Ongchin,
  • Michael Foote,
  • Michael Kluger,
  • Michael Wach,
  • Michael White,
  • Mikaël Soucisse,
  • Mio Kitano,
  • Mohamed Adam,
  • Mohammad Haroon Asif Choudry,
  • Mohammed Suraju,
  • Mojgan Hosseini,
  • Mustafa Raoof,
  • Nabil Wasif,
  • Nadège Fackche,
  • Nader Hanna,
  • Nancy Baxter,
  • Neal Bhutiani,
  • Nelya Melnitchouk,
  • Nikoloas Dallas,
  • Niraj J. Gusani,
  • Oliver S. Eng,
  • Olivier Glehen,
  • Pathik Aravind,
  • Patricio Polanco,
  • Patrick Wagner,
  • Paul Helft,
  • Paul Mansfield,
  • Paul Sugarbaker,
  • Prakash Pandalai,
  • Quan P Ly,
  • Rachel Kim,
  • Rachyl Shanker,
  • Raed Al-Rajabi,
  • Raghav Sundar,
  • Rajiv Agarwal,
  • Rebecca Wiatrek,
  • H. Richard Alexander,
  • Richard Hoehn,
  • Rita Akumuo,
  • Robert Barone,
  • Robert Sticca,
  • Ruo Zhu Chen,
  • Rupen Shah,
  • Ryan Merkow,
  • Sabha Ganai,
  • Sam George Pappas,
  • Samantha Ruff,
  • Sameer Patel,
  • Samer Naffouje,
  • Samuel D. Butensky,
  • Sanjay Bagaria,
  • Sara Daniel,
  • Sarah Wilkins,
  • Scott Sherman,
  • Sean Dineen,
  • Seth Concors,
  • Shannon Altpeter,
  • Shannon Radomski,
  • Sherif Abdel-Misih,
  • Stacey Stein,
  • Stephanie Greco,
  • Susan Campbell,
  • TClark Gamblin,
  • Taylor Jaraczewski,
  • Thinzar Lwin,
  • Thorvardur Halfdanarson,
  • Travis Grotz,
  • Umut Sarpel,
  • Uqba Khan,
  • Vadim Gushchin,
  • Wilbur B. Bowne,
  • Xavier Keutgen,
  • Xiang Gao

摘要

Background

Malignant gastrointestinal obstruction (MGIO), a frequent complication of peritoneal surface malignancies (PSM), often portends a poor prognosis. The lack of high-quality evidence on optimal management strategies necessitated a national consensus to address this clinical problem.

Methods

A clinical management pathway was designed through a Delphi consensus process with national experts in peritoneal disease. Two rounds of voting were conducted to assess agreement levels with pathway blocks. Supporting evidence regarding procedural interventions for MGIO underwent evaluation via a rapid literature review.

Results

Of 111 participants responding in the first round, 90 (81%) responded in the second round. Over 90% consensus was achieved in 4/6 and 6/6 pathway blocks during rounds I and II, respectively. Encouraging a multidisciplinary approach, the pathway emphasized early palliative care assessments and iterative goals of care evaluation throughout treatment. Management was delineated on the basis of obstruction acuity, and selection criteria for palliative-intent surgical interventions and stenting were elucidated. Studies demonstrated limited benefits for such interventions in patients with multifocal obstructions, poor performance status, and high-grade and/or high-burden PSMs. In these cases, a recommendation for supportive care or upper GI decompression tube placement was favored. The overall level of evidence was generally low–moderate in existing literature.

Conclusions

Given limited evidence, the consensus-driven pathway provides crucial clinical guidance for practitioners dealing with MGIO in patients with PSM. There is a need for high-quality prospective evidence in this domain.