Lavage in upper GI bleed

Q: Nasogastric Lavage in upper gastrointestinal (GI) bleed is associated with? (select one) 

A) shorter time to endoscopy

B) reduced mortality

C) decrease length of hospital stay

D) decrease rate of surgery

E) decrease rate of transfusion 

Answer: A

Previously it was a common practice to insert a nasogastric tube (NGT) in patients with suspected upper GI bleed. This practice failed to show any benefit in mortality (choice B), length of hospital stay (choice C), surgery (choice D), or transfusion requirement (Choice E). The only advantage is a shorter time to endoscopy. Also, it can be used to clean the stomach (like blood clots or food particles) prior to endoscopy. Bilious output from NGT gives an indication that bleed is probably distal to pylorus.

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References:

1. Rockey DC, Ahn C, de Melo SW Jr. Randomized pragmatic trial of nasogastric tube placement in patients with upper gastrointestinal tract bleeding. J Investig Med 2017; 65:759.

 

2. Pallin DJ, Saltzman JR. Is nasogastric tube lavage in patients with acute upper GI bleeding indicated or antiquated? Gastrointest Endosc 2011; 74:981. 

3. Karakonstantis S, Tzagkarakis E, Kalemaki D, et al. Nasogastric aspiration/lavage in patients with gastrointestinal bleeding: a review of the evidence. Expert Rev Gastroenterol Hepatol 2018; 12:63. 

4. Huang ES, Karsan S, Kanwal F, et al. Impact of nasogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc 2011; 74:971.