From the Guidelines
Nasogastric tubes (NGTs) are a crucial component in the initial management of small bowel obstruction (SBO), providing symptomatic relief and preventing complications such as aspiration pneumonia. The use of NGTs in SBO is supported by recent evidence, including a 2019 narrative review published in the World Journal of Emergency Surgery 1, which highlights the importance of nasogastric suction in decompressing the proximal bowel and preventing aspiration pneumonia.
Key Considerations for NGT Use in SBO
- The standard approach involves using a 16-18 French tube connected to intermittent or continuous low suction (typically 40-60 mmHg) 1.
- NGT decompression is maintained until bowel function returns, typically evidenced by decreased output (<500 mL/24 hours), resolution of abdominal distension, and return of bowel sounds.
- While NGT placement is a cornerstone of conservative SBO management, it's essential to recognize that it doesn't treat the underlying obstruction but rather manages symptoms while the obstruction potentially resolves spontaneously or until definitive treatment can be implemented.
- Patients typically experience discomfort during NGT placement, so appropriate explanation and local anesthetic spray can improve tolerance.
- Regular assessment of tube patency and nasal care are essential to prevent complications like sinusitis or nasal erosion during prolonged use.
Evidence Supporting NGT Use
- A 2019 review published in the World Journal of Emergency Surgery 1 discusses the use of naso-gastric suction or long intestinal tube in the non-operative management of adhesive small bowel obstruction, highlighting the effectiveness of these methods in managing symptoms and potentially avoiding the need for surgical intervention.
- The Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO), updated in 2017 and published in the World Journal of Emergency Surgery 1, recommend nil per os and decompression using a naso-gastric tube or long intestinal tube as the cornerstone of non-operative management, with non-operative management being effective in approximately 70–90% of patients with ASBO.
Conclusion Not Applicable - Direct Answer Only
The use of NGTs in SBO is supported by the most recent and highest quality evidence, including the studies mentioned above 1, which emphasize the importance of NGT decompression in the initial management of SBO to improve patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Role of Nasogastric Tube in Small Bowel Obstruction
- The use of a nasogastric tube (NGT) in managing 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 to Yale New Haven Hospital with SBO found that patients who did not receive NGTs had shorter hospital stays and fewer complications, such as pneumonia and respiratory failure 2.
- Another study found that nonoperative management without NGT decompression for adhesive SBO was safe and effective, with no significant differences in the incidence of vomiting, pneumonia, or need for surgery compared to patients who received NGT decompression 3.
Complications Associated with NGT Use
- The use of NGTs has been associated with complications such as pneumonia, respiratory failure, and pharyngolaryngitis 2, 4.
- A meta-analysis of studies on the use of NGTs after elective colon and rectum surgery found that patients who received NGTs had more pharyngolaryngitis and respiratory infections, but less vomiting and nasogastric tube replacement 4.
Alternative Management Strategies
- Some studies suggest that alternative management strategies, such as selective NGT insertion for patients with persistent nausea or vomiting, may be effective in managing SBO 3.
- A multicenter, randomized controlled trial found that Gastrografin enterography or long tube placement was effective in managing non-strangulated acute small bowel obstruction, with a non-surgery rate of 91.1% in the NGT-G group and 87.4% in the long tube group 5.
Symptom Control in Terminally Ill Patients
- In terminally ill patients with malignant bowel obstruction, symptom control can be achieved without the use of NGTs, using alternative methods such as medical management and palliative care 6.