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 journalArticlepeer-review

15 Scopus citations

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 2017

Keywords

  • Endoscopy
  • Gastrointestinal Hemorrhage
  • Peptic Ulcer

ASJC Scopus subject areas

  • General Biochemistry, Genetics and Molecular Biology

Fingerprint

Dive into the research topics of 'Randomized pragmatic trial of nasogastric tube placement in patients with upper gastrointestinal tract bleeding'. Together they form a unique fingerprint.

Cite this