Can we improve the management of inoperable malignant bowel obstruction? Results of a feasibility study of Elemental Diet as an alternative to parenteral nutrition in patients with advanced gynaecological cancer

Abstract Purpose. Nutrition support in inoperable bowel obstruction (IBO) remains challenging. Parenteral nutrition (PN) is recommended if prognosis is > 2 months. An elemental diet (ED) is licensed for strictures in Crohn’s disease but has not been used in malignant bowel obstruction. The aim of this study was to evaluate the use of ED in patients with IBO and provide a ‘Proof of Concept’ of ED as an acceptable feeding option. Methods. This was a mixed-methods single arm feasibility study. Endpoints included taste acceptability, incidences of vomiting and pain, the proportion of women who tolerated ED, number of cartons drunk, quality of life (QOL) and number of women treated with chemotherapy. Patients (>18 years) with CT-confirmed IBO and able to tolerate 500ml of liquid in 24 hours, remained on the trial for 2 weeks. Results. 29 patients were recruited; of those 19 contributed to the analysis. 13 participants (68.4%) tolerated the ED. Mean number of cartons drunk was 1.72 per day. At the start of the study 72% of patients experienced vomiting, reducing to 23.5% by the end of Day 15. 96% of patients reported pain at consent, reducing to 76% by Day 15. QOL scores improved from 36.23 at baseline to 53.13 at the end of Day 15. 13 (68%) participants commenced chemotherapy within the first week of starting ED. Conclusion. ED is well tolerated by patients with IBO caused by gynaecological malignancies and may have a positive effect on symptom burden and QOL.