From the Guidelines
The use of nasogastric (NG) tubes in small bowel obstruction (SBO) should be individualized, with a trial of conservative management without NG tube being reasonable for uncomplicated partial SBO, reserving NG tubes for patients with significant symptoms or those failing conservative management. For patients with SBO, non-operative management is effective in approximately 70–90% of cases, and the cornerstone of this management is nil per os and decompression using a naso-gastric tube or long intestinal tube 1. However, the decision to use an NG tube should be based on the severity of obstruction, patient symptoms, and response to initial management.
When considering the use of NG tubes, it is essential to weigh the potential benefits against the drawbacks. NG tubes can decompress the stomach and proximal small bowel, potentially reducing vomiting, aspiration risk, and abdominal distention. However, they can also cause significant patient discomfort, delay oral intake, and may prolong hospital stays without clearly improving outcomes in all cases 1.
In terms of resolution of SBO, clinical improvement, return of bowel function, and radiographic improvement should be monitored 1. The management of SBO should also involve early surgical consultation to identify patients who may need operative intervention. Recent studies suggest that a high incidence of adhesions also occurs in patients with SBO in the virgin abdomen, which could have important implications for treatment 1.
Key points to consider in the management of SBO include:
- Non-operative management is effective in approximately 70–90% of cases
- NG tubes should be reserved for patients with significant symptoms or those failing conservative management
- The decision to use an NG tube should be individualized based on the severity of obstruction, patient symptoms, and response to initial management
- Clinical improvement, return of bowel function, and radiographic improvement should be monitored
- Early surgical consultation is essential to identify patients who may need operative intervention.
From the Research
NG Tube vs No NG Tube in Resolution of SBO
- The use of nasogastric (NG) tubes in the management of small bowel obstruction (SBO) has been a topic of debate, with some studies suggesting that it may not be necessary for all patients 2, 3.
- A retrospective chart review of adult patients admitted with SBO found that patients who did not receive NG tubes had shorter hospital stays and fewer complications, such as pneumonia and respiratory failure 2.
- Another study found that patients who received nonoperative management without NG tube decompression for adhesive SBO had similar outcomes to those who received NG tube decompression, including incidence of vomiting, pneumonia, and need for surgery 3.
- A review of outcomes associated with NG tube use in a large tertiary center found that patients who received an NG tube had poorer outcomes, including longer hospital stays and increased need for surgical intervention 4.
- The evidence suggests that the routine use of NG tubes in SBO may not be necessary, and that selective use of NG tubes for patients with persistent nausea or vomiting may be a viable alternative 5, 3.
Comparison of Outcomes
- Studies have compared outcomes between patients who received NG tubes and those who did not, including:
- Time to resolution: patients without NG tubes had shorter times to resolution 2, 4.
- Hospital length of stay: patients without NG tubes had shorter hospital stays 2, 4.
- Complications: patients without NG tubes had fewer complications, such as pneumonia and respiratory failure 2.
- Need for surgery: patients without NG tubes had a lower need for surgical intervention 4.
Clinical Implications
- The findings of these studies have implications for clinical practice, suggesting that the routine use of NG tubes in SBO may not be necessary 2, 3, 4.
- Clinicians may consider selective use of NG tubes for patients with persistent nausea or vomiting, rather than routine use for all patients with SBO 5, 3.
- Further research is needed to fully understand the role of NG tubes in the management of SBO and to inform evidence-based practice 4.