From the Research
Nasogastric (NG) tubes are generally contraindicated in bariatric patients who have undergone certain bariatric procedures, particularly Roux-en-Y gastric bypass and sleeve gastrectomy, due to the risk of perforating the staple lines or causing damage to the surgically altered anatomy, as highlighted in the most recent study 1. The primary concern is the risk of complications, such as perforation, bleeding, or damage to surgical anastomoses, which can lead to increased morbidity and mortality. Some key points to consider when dealing with bariatric patients include:
- The risk of perforating the staple lines or causing damage to the surgically altered anatomy is high, especially in patients who have undergone Roux-en-Y gastric bypass and sleeve gastrectomy 2.
- Alternative approaches, such as enteral feeding or gastric decompression, should be considered for bariatric patients who require nutritional support or gastric decompression 3.
- If an NG tube is absolutely necessary, it should only be placed by experienced clinicians, preferably under radiological guidance, using a smaller caliber tube than standard, as suggested by the European Society of Gastrointestinal Endoscopy (ESGE) Guideline 1.
- For patients with adjustable gastric bands, the band may need to be deflated before attempting NG tube placement, and post-bariatric surgery patients often have altered gastric anatomy that makes blind NG tube insertion dangerous 4.
- In emergency situations where gastric decompression is critical, consultation with a bariatric surgeon is essential before attempting NG tube placement, and alternative methods for medication administration, such as liquid formulations or crushed tablets (when appropriate), should be considered for these patients 5.