番茄社区

CHICAGO -- Placement of a nasogastric tube for determining treatment of patients with upper gastrointestinal bleeding may be unnecessary since almost all these patients will eventually undergo an endoscopic procedure, researchers argued here.

"We found that the clinical judgment of the clinician was just about as good as a nasogastric tube examination -- and didn't cause harm to the patient," said , of Gastroenterology Consultants in San Antonio.

The diagnosis by clinical judgment was confirmed in 52% of the patients in the study, while the nasogastric tube analysis was correct 60% of the time -- results which achieved prespecified non-inferiority, said co-author , of the Medical University of South Carolina in Charleston.

"Since there is going to be an endoscopic follow-up to confirm the diagnosis and perform definitive treatment if necessary, there is no need to continue to torture our patients with nasogastric tube placement," Rockey told 番茄社区 at the annual Digestive Disease Week. He and Melo said they no longer routinely order it.

"We found that that routine placement of an nasogastric tube is not helpful in patients with upper gastrointestinal bleeding," he said.

Melo told 番茄社区 that placement of nasogastric tubes cause pain and epistaxis in as many as 25% of patients undergoing the procedure; in another 10% of patients, the tube cannot be inserted due to some form of anatomic problem. In the study he performed, pain, nasal bleeding, or nasogastric tube failure occurred in 49 of the 140 (35%) patients assigned to that procedure.

Rockey said the use of the nasogastric tube for diagnosis and lavage of patients coughing up blood or having blood in their stools has been commonplace as treatment for suspected upper gastrointestinal bleeding for more than a century. But with the advent of endoscopy use beginning in the 1980s, the nasogastric tube has probably not been needed -- even though it is performed almost daily in many U.S. hospitals.

Melo said that use of the nasogastric tube in hospitals outside the U.S. and in less developed countries such as his native Brazil may still be used because of the lack of widespread endoscopists.

In the study, 280 patients with suspected upper gastrointestinal bleeding were randomized into two groups -- one in which a nasogastric tube was placed in the patient and a diagnosis was derived from the aspiration and lavage, and a second group of 140 patients whose diagnosis was determined through a clinical evaluation and patient history. The study was conducted at the University of Texas Southwestern Medical Center in Dallas, when Melo and Rockey were both working at that facility.

"Recruitment of patients for the study was a challenge," Rockey sad. "Many patients refused to undergo the nasogastric tube placement." Those patients who refused were also followed as to their outcomes, and their clinical diagnosis turned out to be similar to the others, he said.

The patients were about 50 years old, and 35% were women. The patients were matched for pre-endoscopic vital signs and laboratory tests. The clinicians' prediction for the need for endoscopic repair was correct 32% of the time; the prediction based on nasogastric findings was correct 38% of the time (P=0.7).

"Although nasogastric tube placement, aspiration, and lavage is often used in patients with upper gastrointestinal bleeding, its clinical utility remains unproven," Rockey said.