Original articleClinical endoscopyImpact of nasogastric lavage on outcomes in acute GI bleeding
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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Initial Assessment, Risk Stratification, and Early Management of Acute Nonvariceal Upper Gastrointestinal Hemorrhage
2018, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :Singer and colleagues42 evaluated 15 of the most common procedures performed in the emergency department and found that NG intubation was the most painful according to patients, even more so than abscess drainage, fracture reduction, or urethral catheterization. Although NG lavage has been associated with an earlier time to endoscopy, this does not affect clinical outcomes such as mortality, LOS, or need for surgery or transfusion.43 Furthermore, a recent single-blind, prospective, randomized, noninferiority study of 280 subjects confirmed that routine NG tube placement and lavage did not improve the probability of finding a high-risk lesion on endoscopy, did not affect rebleeding or mortality rates, and was complicated by pain and bleeding nares in a quarter of subjects.44
Evaluation and management of Non-variceal upper gastrointestinal bleeding
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2023, Endoscopy International OpenEvolving Therapeutic Roles of Nasogastric Tubes: Current Concepts in Clinical Practice
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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].