Impact of nasogastric lavage on outcomes in acute GI bleeding

• Published in: Gastrointestinal endoscopy Vol. 74; no. 5; pp. 971 - 980
• Main Authors: Huang, Edward S., MD, MPH, Karsan, Sundip, MD, MPH, Kanwal, Fasiha, MD, MSHS, Singh, Inder, MD, Makhani, Marc, MD, Spiegel, Brennan M., MD, MSHS
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01-11-2011; Elsevier
• Subjects: Aged; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Biological and medical sciences; Blood Transfusion - statistics & numerical data; Digestive system. Abdomen; Endoscopy; Endoscopy, Gastrointestinal; Female; Gastric Lavage; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Contents; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - surgery; Humans; Investigative techniques, diagnostic techniques (general aspects); Length of Stay - statistics & numerical data; Logistic Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Odds Ratio; Other diseases. Semiology; Propensity Score; Proportional Hazards Models; Retrospective Studies; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; nonsteroidal anti-inflammatory drugs; NGL; OR; NVUGIH; nonvariceal upper GI hemorrhage; NSAIDs; odds ratio; nasogastric lavage; Digestive diseases; Intestinal disease; Prognosis; Gastrointestinal bleeding; Acute; Nasogastric
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.04.045

Background Nasogastric lavage (NGL) is often performed early in the management of GI bleeding. This practice assumes that NGL results can assist with timely risk stratification and management. Objective We performed a retrospective analysis to test whether NGL is associated with improved process measures and outcomes in GI bleeding. Design Propensity-matched retrospective analysis. Setting University-based Veterans Affairs medical center. Patients A total of 632 patients admitted with GI bleeding. Main Outcome Measurements Thirty-day mortality rate, length of hospital stay, transfusion requirements, surgery, and time to endoscopy. Results Patients receiving NGL were more likely to take nonsteroidal anti-inflammatory drugs and be admitted to intensive care, but less likely to have metastatic disease or tachycardia, be taking warfarin, or present on weekdays. After propensity matching, NGL did not affect mortality (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.37-1.92), length of hospital stay (7.3 vs 8.1 days, P = .57), surgery (OR 1.51; 95% CI, 0.42-5.43), or transfusions (3.2 vs 3.0 units, P = .94). However, NGL was associated with earlier time to endoscopy (hazard ratio 1.49; 95% CI, 1.09-2.04), and bloody aspirates were associated high-risk lesions (OR 2.69; 95% CI, 1.08-6.73). Limitations Retrospective design. Conclusions Performing NGL is associated with the earlier performance of endoscopy, but does not affect clinical outcomes. Performing NGL at initial triage may promote more timely process of care, but further studies will be needed to confirm these findings.