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.
Contraindications for NG Tube Placement in Bariatric Patients
The primary concern with NG tube placement in bariatric patients is the risk of complications, including:
- Perforation of the staple lines
- Damage to the surgically altered anatomy
- Bleeding or disruption of surgical anastomoses Specific contraindications for NG tube placement in bariatric patients include:
- Recent bariatric surgery (especially within the first 4-6 weeks post-operation) 2
- Known anastomotic leaks, strictures, or fistulas
- Altered anatomy that may make blind insertion of an NG tube risky
Alternative Approaches for Enteral Feeding or Gastric Decompression
For bariatric patients who require enteral feeding or gastric decompression, alternative approaches should be considered, such as:
- Post-pyloric feeding tubes placed endoscopically or radiologically
- Parenteral nutrition if enteral access is not feasible
- Dual-lumen gastrojejunostomy tubes for both gastric decompression and feeding 1
Precautions for NG Tube Placement in Bariatric Patients with Intact Anatomy
For bariatric patients with intact anatomy who haven't undergone surgery yet, standard precautions for NG tube placement apply, including:
- Assessing for esophageal varices
- Recent esophageal surgery
- Severe coagulopathy It is essential to weigh the benefits and risks of NG tube placement in bariatric patients and consider alternative approaches to minimize the risk of complications, as recommended by the European Society of Gastrointestinal Endoscopy (ESGE) 3.