Response to Demarest et al.

We read with interest the article “Comprehensive Diagnosis and Management of Malignant Bowel Obstruction: A Review” (1). Malignant bowel obstructions (MBO) are common in the palliative care context yet can be challenging to manage because of the sparse evidence base. Even though we must often practice with a paucity of randomized-controlled trials (RCTs) to guide us, an understanding of pharmacology and the best available evidence can help us navigate. Unfortunately, the article by Demarest et al. did not capture common clinical controversies in palliative management of MBO, omitting some key contributions of evidence and did not disclose uncertainty where it is present. Several statements are at issue: