Managing Malignant Small Bowel Obstruction Near the End of Life

Patients who present with malignant bowel obstruction generally have poor prognoses. Tradeoffs between surgical and nonsurgical approaches often are unclear, given the need to balance palliation of symptoms, surgical complications, expected mortality, and individual preferences.

In this study, 199 hospitalized adults with incurable malignant small bowel obstruction in the U.S., Mexico, Peru, and Columbia were offered randomization to surgical or nonsurgical treatment; 49 accepted randomization, and the remaining patients chose surgical or nonsurgical treatment, according to their preferences. The randomized and nonrandomized cohorts were analyzed together, with multivariable adjustment for baseline differences.

At 30 days postintervention, pa…