712 NASOGASTRIC TUBE DRAINAGE AND PYLORIC INTERVENTIONS FOR DELAYED GASTRIC EMPTYING AFTER OESOPHAGEAL RESECTION: A NATIONAL ANALYSIS OF SPECIALIST UK CENTRES

Abstract

Abstract Nasogastric tubes (NGTs) and pyloric intervention in oesophagectomy are used to lessen the impact of gastric tube distention and delayed gastric emptying. However, their utility remains unclear, with mixed evidence and some studies suggesting they may increase morbidity and patient discomfort. We performed a national survey of tertiary oesophageal surgery centres to assess current practice and surgeon equipoise for a potential prospective trial. Methods An electronic survey was distributed to all oesophageal resection centres in England, Wales and Scotland. Included questions assessed centres’ use of NGTs, current practice for removal and dietary progression, and use of pyloric interventions. Variations in practice were assessed, and compared to nationally reported annual centre volumes and length of stay. Results Seventy-nine percent (31/39) of all centres responded to the survey. All centres reported routinely using an NGT. Most centres (19/31, 61%) did not perform pyloric intervention or routine post-operative radiological assessment (22/31, 71%). Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different practice criteria. There were no trends for practices when comparing high vs low volume centres, or above vs at-or-below median length of stay. 21/31 (68%) centres were willing to take part in a trial to assess NGT use and pyloric interventions. Conclusion NGTs remain standard practice despite mixed evidence for their efficacy and an absence of standardisation in their use. Use of pyloric intervention varies widely, with no clear link to outcomes. Surgeons recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection.