Randomized pragmatic trial of nasogastric tube placement in patients with upper gastrointestinal tract bleeding

Don C. Rockey, Chul Ahn, Silvio W. De Melo

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

The value of nasogastric (NG) tube placement in patients with upper gastrointestinal tract bleeding (UGIB) is unclear. We therefore aimed to determine the usefulness of NG tube placement in patients with UGIB. The study was a single-blind, randomized, prospective, non-inferiority study comparing NG placement (with aspiration and lavage) to no NG placement (control). The primary outcome was the probability that physicians could predict the presence of a high-risk lesion (ie, requiring endoscopic therapy). 140 patients in each arm were included; baseline clinical features were similar in each group. The probability that there would be a high-risk lesion in the control arm was predicted to be 35% compared with 39% in the NG arm (after NG placement) - a probability difference of -4% (95% CI -12% to 3%), which confirmed non-inferiority of the 2 arms (p=0.002). All patients underwent endoscopy and all patients with high-risk lesions had endoscopic therapy. Physicians predicted the specific culprit lesion in 38% (53/140) and 39% (55/140) of patients in the control and NG (after NG placement) groups, respectively. The presence of coffee grounds or red blood in the NG aspirate did not change physician assessments. Pain, nasal bleeding, or failure of NG occurred in 47/140 (34%) patients. There were no differences in rebleeding rates or mortality. In patients with acute UGIB, the ability of physicians to predict culprit bleeding lesions and/or the presence of high-risk lesions was poor. Routine NG placement did not improve physician's predictive ability, did not affect outcomes, and was complicated in one-third of patients. Trail Registration Number: NCT00689754.

Original languageEnglish (US)
Pages (from-to)759-764
Number of pages6
JournalJournal of Investigative Medicine
Volume65
Issue number4
DOIs
StatePublished - Apr 1 2017

Fingerprint

Pragmatic Clinical Trials
Upper Gastrointestinal Tract
Hemorrhage
Physicians
Coffee
Endoscopy
Aptitude
Blood
Epistaxis
Therapeutic Irrigation

Keywords

  • Endoscopy
  • Gastrointestinal Hemorrhage
  • Peptic Ulcer

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Randomized pragmatic trial of nasogastric tube placement in patients with upper gastrointestinal tract bleeding. / Rockey, Don C.; Ahn, Chul; De Melo, Silvio W.

In: Journal of Investigative Medicine, Vol. 65, No. 4, 01.04.2017, p. 759-764.

Research output: Contribution to journalArticle

@article{08cf59ee82a44abdb766775737cc064a,
title = "Randomized pragmatic trial of nasogastric tube placement in patients with upper gastrointestinal tract bleeding",
abstract = "The value of nasogastric (NG) tube placement in patients with upper gastrointestinal tract bleeding (UGIB) is unclear. We therefore aimed to determine the usefulness of NG tube placement in patients with UGIB. The study was a single-blind, randomized, prospective, non-inferiority study comparing NG placement (with aspiration and lavage) to no NG placement (control). The primary outcome was the probability that physicians could predict the presence of a high-risk lesion (ie, requiring endoscopic therapy). 140 patients in each arm were included; baseline clinical features were similar in each group. The probability that there would be a high-risk lesion in the control arm was predicted to be 35{\%} compared with 39{\%} in the NG arm (after NG placement) - a probability difference of -4{\%} (95{\%} CI -12{\%} to 3{\%}), which confirmed non-inferiority of the 2 arms (p=0.002). All patients underwent endoscopy and all patients with high-risk lesions had endoscopic therapy. Physicians predicted the specific culprit lesion in 38{\%} (53/140) and 39{\%} (55/140) of patients in the control and NG (after NG placement) groups, respectively. The presence of coffee grounds or red blood in the NG aspirate did not change physician assessments. Pain, nasal bleeding, or failure of NG occurred in 47/140 (34{\%}) patients. There were no differences in rebleeding rates or mortality. In patients with acute UGIB, the ability of physicians to predict culprit bleeding lesions and/or the presence of high-risk lesions was poor. Routine NG placement did not improve physician's predictive ability, did not affect outcomes, and was complicated in one-third of patients. Trail Registration Number: NCT00689754.",
keywords = "Endoscopy, Gastrointestinal Hemorrhage, Peptic Ulcer",
author = "Rockey, {Don C.} and Chul Ahn and {De Melo}, {Silvio W.}",
year = "2017",
month = "4",
day = "1",
doi = "10.1136/jim-2016-000375",
language = "English (US)",
volume = "65",
pages = "759--764",
journal = "Journal of Investigative Medicine",
issn = "1081-5589",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Randomized pragmatic trial of nasogastric tube placement in patients with upper gastrointestinal tract bleeding

AU - Rockey, Don C.

AU - Ahn, Chul

AU - De Melo, Silvio W.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - The value of nasogastric (NG) tube placement in patients with upper gastrointestinal tract bleeding (UGIB) is unclear. We therefore aimed to determine the usefulness of NG tube placement in patients with UGIB. The study was a single-blind, randomized, prospective, non-inferiority study comparing NG placement (with aspiration and lavage) to no NG placement (control). The primary outcome was the probability that physicians could predict the presence of a high-risk lesion (ie, requiring endoscopic therapy). 140 patients in each arm were included; baseline clinical features were similar in each group. The probability that there would be a high-risk lesion in the control arm was predicted to be 35% compared with 39% in the NG arm (after NG placement) - a probability difference of -4% (95% CI -12% to 3%), which confirmed non-inferiority of the 2 arms (p=0.002). All patients underwent endoscopy and all patients with high-risk lesions had endoscopic therapy. Physicians predicted the specific culprit lesion in 38% (53/140) and 39% (55/140) of patients in the control and NG (after NG placement) groups, respectively. The presence of coffee grounds or red blood in the NG aspirate did not change physician assessments. Pain, nasal bleeding, or failure of NG occurred in 47/140 (34%) patients. There were no differences in rebleeding rates or mortality. In patients with acute UGIB, the ability of physicians to predict culprit bleeding lesions and/or the presence of high-risk lesions was poor. Routine NG placement did not improve physician's predictive ability, did not affect outcomes, and was complicated in one-third of patients. Trail Registration Number: NCT00689754.

AB - The value of nasogastric (NG) tube placement in patients with upper gastrointestinal tract bleeding (UGIB) is unclear. We therefore aimed to determine the usefulness of NG tube placement in patients with UGIB. The study was a single-blind, randomized, prospective, non-inferiority study comparing NG placement (with aspiration and lavage) to no NG placement (control). The primary outcome was the probability that physicians could predict the presence of a high-risk lesion (ie, requiring endoscopic therapy). 140 patients in each arm were included; baseline clinical features were similar in each group. The probability that there would be a high-risk lesion in the control arm was predicted to be 35% compared with 39% in the NG arm (after NG placement) - a probability difference of -4% (95% CI -12% to 3%), which confirmed non-inferiority of the 2 arms (p=0.002). All patients underwent endoscopy and all patients with high-risk lesions had endoscopic therapy. Physicians predicted the specific culprit lesion in 38% (53/140) and 39% (55/140) of patients in the control and NG (after NG placement) groups, respectively. The presence of coffee grounds or red blood in the NG aspirate did not change physician assessments. Pain, nasal bleeding, or failure of NG occurred in 47/140 (34%) patients. There were no differences in rebleeding rates or mortality. In patients with acute UGIB, the ability of physicians to predict culprit bleeding lesions and/or the presence of high-risk lesions was poor. Routine NG placement did not improve physician's predictive ability, did not affect outcomes, and was complicated in one-third of patients. Trail Registration Number: NCT00689754.

KW - Endoscopy

KW - Gastrointestinal Hemorrhage

KW - Peptic Ulcer

UR - http://www.scopus.com/inward/record.url?scp=85017024666&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017024666&partnerID=8YFLogxK

U2 - 10.1136/jim-2016-000375

DO - 10.1136/jim-2016-000375

M3 - Article

C2 - 28069629

AN - SCOPUS:85017024666

VL - 65

SP - 759

EP - 764

JO - Journal of Investigative Medicine

JF - Journal of Investigative Medicine

SN - 1081-5589

IS - 4

ER -