Paper: Fonseca, A. L., Schuster, K. M., Maung, A. A., Kaplan, L. J., & Davis, K. A. (2013). Routine Nasogastric decompression in small bowel obstruction: Is it really necessary? The American Surgeon, 79(4), 422-428
What: Retrospective review of patients > 18 years old admitted to Yale New Haven Hospital with a diagnosis of SBO over a 5-year period. Outcomes looked at were days to SBO resolution, length of hospital stay, complications, and discharge to nursing home/rehabilitation facility between those who did and did not receive NGT decompression
First10inEM covers the topic here: https://first10em.com/ng-tubes-for-small-bowel-obstruction-more-pain-than-evidence/
Details: Out of 290 patients who met inclusion criteria, 235 patients received NGT decompression while 55 did not. A history of diabetes, CT scan documenting the absence of colonic air, and larger gastric volume as recorded on CT scan were predictive of NGT placement. Of note, abdominal distension (OR 0.25, p = 0.045) and tympany (OR 0.29, p = 0.035) were negative predictors of NGT insertion (OR 0.25 and 0.29 respectively) and 73% of patients without active emesis had NGT placement. This suggests nasogastric tube placement was done empirically rather than in response to specific clinical features. Days to resolution (3.55 vs 1.67 days) and length of stay (10.16 vs 3.18 days) were increased in those receiving NGT decompression (p < 0.001) compared with those who did not. Although placement was not associated with increased risk of operative intervention, NGT placement did result in statistically significant increase in overall complications rates (p < 0.001), including pneumonia (p = 0.007) and respiratory failure (p = 0.013) during hospital stay. Not surprisingly, these patients were much more likely to be discharged to a nursing home or rehabilitation facility (OR 6.62, p < 0.004). Limitations to this study include selections bias, single site enrollment, and possible recall/misclassification bias.
SBO is a commonly encountered diagnosis in our emergency department requiring consultation with surgical services and admission to the hospital. NGT placement has classically been included in the nonoperative management of SBO, and as such emergency physicians are commonly asked to place them prior to admission. Outside of the inherent risks and complications associated with NGT placement, it’s also one of the most painful medical procedures self-reported by patients. NGT placement is also not associated with reduction in surgery and bowel ischemia (Berman 2017). All this to say, think twice and discuss with your attendings and colleagues prior to empirically placing an NGT, particularly in those with without significant distention and vomiting.
Written by:
Garrett Prince, MD – PGY 3 | Cook County Health
Carlos Mikell, MD – PGY 3 | Cook County Health
Reviewed by:
Jorge Aceves, MD
Department of Emergency Medicine | Cook County Health