Surgery · Oncology · Gastroenterology · 1 h ago
North American Delphi panel issues 49 recommendations for malignant bowel obstruction
A multidisciplinary modified Delphi process developed 49 consensus statements to guide medical, surgical and palliative management of malignant bowel obstruction (MBO). Experts reviewed statements in two survey rounds and a consensus meeting, using an 80% agreement threshold; the recommendations address assessment, treatment decisions and end-of-life care.
- Forty-nine consensus statements cover four areas of MBO care.
- Statements were developed through two survey rounds and a consensus meeting.
- Recommendations address surgery, medicines and palliative decisions.
- Expert consensus provides a framework, not evidence of improved outcomes.
Malignant bowel obstruction is a complex complication of incurable cancer, and high-quality evidence to guide management is limited. This North American modified Delphi study brought together experts from specialties involved in MBO care, including surgery, oncology, gastroenterology, radiology and palliative care. A scoping review informed draft statements, which were assessed in two survey rounds and a virtual consensus meeting. Agreement was defined in advance as at least 80%. The article does not specify the number of participating panellists in the supplied text.
The panel approved 49 evidence-informed statements covering patient assessment, medical management, surgical management and palliative care, as well as a unified definition of MBO. Topics included preoperative assessment and multidisciplinary review; the timing and use of steroids, pro-motility and antisecretory medicines; circumstances in which surgery may be inappropriate; consent and perioperative decisions; and the use of gastrostomies and intravenous fluids near the end of life.
The statements offer a structured framework for decisions that must account for prognosis, available cancer treatment, patient preferences and risk of harm. They are expert consensus, not trial evidence demonstrating improved outcomes, and should be interpreted in light of the limited underlying evidence and the individualized nature of MBO care.
In practice
For clinicians caring for patients with incurable cancer and MBO, the 49 statements provide a multidisciplinary framework for assessment and for medical, surgical and palliative decisions, including discussion of operative suitability, consent, gastrostomies and intravenous fluids near the end of life. This may help structure individualized team discussions around prognosis and patient values. The recommendations are based on expert consensus in a field with limited high-quality evidence; they do not establish that following the statements improves outcomes or replace patient-specific judgment.
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Annals of Surgical Oncology: Recommendations for the Multimodal Management of Malignant Bowel Obstructions: Results of a North American Multidisciplinary Delphi Consensus ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.