Elsevier

Gastrointestinal Endoscopy

Volume 74, Issue 5, November 2011, Pages 971-980
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Impact of nasogastric lavage on outcomes in acute GI bleeding

https://doi.org/10.1016/j.gie.2011.04.045Get rights and content

Background

Nasogastric lavage (NGL) is often performed early in the management of GI bleeding. This practice assumes that NGL results can assist with timely risk stratification and management.

Objective

We performed a retrospective analysis to test whether NGL is associated with improved process measures and outcomes in GI bleeding.

Design

Propensity-matched retrospective analysis.

Setting

University-based Veterans Affairs medical center.

Patients

A total of 632 patients admitted with GI bleeding.

Main Outcome Measurements

Thirty-day mortality rate, length of hospital stay, transfusion requirements, surgery, and time to endoscopy.

Results

Patients receiving NGL were more likely to take nonsteroidal anti-inflammatory drugs and be admitted to intensive care, but less likely to have metastatic disease or tachycardia, be taking warfarin, or present on weekdays. After propensity matching, NGL did not affect mortality (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.37-1.92), length of hospital stay (7.3 vs 8.1 days, P = .57), surgery (OR 1.51; 95% CI, 0.42-5.43), or transfusions (3.2 vs 3.0 units, P = .94). However, NGL was associated with earlier time to endoscopy (hazard ratio 1.49; 95% CI, 1.09-2.04), and bloody aspirates were associated high-risk lesions (OR 2.69; 95% CI, 1.08-6.73).

Limitations

Retrospective design.

Conclusions

Performing NGL is associated with the earlier performance of endoscopy, but does not affect clinical outcomes. Performing NGL at initial triage may promote more timely process of care, but further studies will be needed to confirm these findings.

Section snippets

Study setting and patients

We performed a retrospective study of consecutive patients presenting to the emergency department of West Los Angeles Veterans Affairs Medical Center with GI bleeding between January 1996 and December 2005. The center is the primary inpatient site for 79,000 patients served by the VA Greater Los Angeles Healthcare System and is a primary academic teaching hospital for the UCLA Gastroenterology Fellowship Training Program. All hemostasis cases are handled by a gastroenterology fellow in

Baseline characteristics

Of the 2382 hospitalizations retrieved, 632 patients met our inclusion and exclusion criteria and comprised the study population. We excluded 1750 patients from the analysis because 1619 were admitted for anemia or did not have a primary diagnosis of GI bleeding, and 131 had inpatient bleeding events. Of the remaining patients, 60% underwent pre-endoscopic NGL. The mean age ± standard deviation was 63.1 ± 13.4 years, and 98% were men. Endoscopy was performed in 68.4% of patients, 26.3% of whom

Discussion

It remains uncertain whether early NGL improves patient outcomes in the management of acute GI bleeding. However, consensus guidelines have recommended considering NGL for pre-endoscopy evaluation because NGL often has prognostic value.22 Data indicate that NGL offers important information for risk stratification, and the presence of fresh blood in the NGL aspirate predicts active bleeding, high-risk lesions, and higher rates of recurrent hemorrhage.11, 12, 13, 23, 24 However, other studies

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    DISCLOSURE: The authors disclosed no financial relationships relevant to this publication. Dr. Huang is supported by American Gastroenterological Association Fellowship to Faculty Transition Award. There was no external funding for this study. The opinions and assertions contained herein are the sole views of the authors and are not to be construed as official or as reflecting the views of the Department of Veteran Affairs.

    If you would like to chat with an author of this article, you may contact Dr. Spiegel at [email protected].

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