Selected nasogastric lavage in patients with nonvariceal upper gastrointestinal bleeding

Eun Jeong Gong,Koon Hee Han,Myeongsook Seo,Sang Jin Lee,Gab Jin Cheon,Woo Jin Jeong,Young Don Kim,Min-Ju Kim,Jong Kyu Park,Baek Gyu Jun,Hyun Il Seo,Li-Chang Hsing

doi:10.1186/s12876-021-01690-z

Abstract

BackgroundRisk stratification before endoscopy is crucial for proper management of patients suspected as having upper gastrointestinal bleeding (UGIB). There is no consensus regarding the role of nasogastric lavage for risk stratification. In this study, we investigated the usefulness of nasogastric lavage to identify patients with UGIB requiring endoscopic examination.MethodsFrom January 2017 to December 2018, patients who visited the emergency department with a clinical suspicion of UGIB and who underwent nasogastric lavage before endoscopy were eligible. Patients with esophagogastric variceal bleeding were excluded. The added predictive ability of nasogastric lavage to the Glasgow–Blatchford score (GBS) was estimated using category-free net reclassification improvement and integrated discrimination improvement.ResultsData for 487 patients with nonvariceal UGIB were analyzed. The nasogastric aspirate was bloody in 67 patients (13.8 %), coffee-ground in 227 patients (46.6 %), and clear in 193 patients (39.6 %). The gross appearance of the nasogastric aspirate was associated with the presence of UGIB. Model comparisons showed that addition of nasogastric lavage findings to the GBS improved the performance of the model to predict the presence of UGIB. Subgroup analysis showed that nasogastric lavage improved the performance of the prediction model in patients with the GBS ≤ 11, whereas no additive value was found when the GBS was greater than 11.ConclusionsNasogastric lavage is useful for predicting the presence of UGIB in a subgroup of patients, while its clinical utility is limited in high-risk patients with a GBS of 12 or more.

Highlights

Risk stratification before endoscopy is crucial for proper management of patients suspected as having upper gastrointestinal bleeding (UGIB)
In this study, we investigated the usefulness of nasogastric lavage for prediction of nonvariceal UGIB and found that the additive value of nasogastric lavage during risk stratification of patients differs by the Glasgow–Blatchford score (GBS)
Prediction of nonvariceal UGIB using non‐endoscopic variables Logistic regression analysis showed that the Blood urea nitrogen (BUN)/Cr ratio > 30, a higher GBS score, and a coffee-ground or bloody nasogastric aspirate were factors associated with the presence of nonvariceal UGIB on endoscopy (Additional file 3: Table 2)

Summary

Introduction

Risk stratification before endoscopy is crucial for proper management of patients suspected as having upper gastrointestinal bleeding (UGIB). We investigated the usefulness of nasogastric lavage to identify patients with UGIB requiring endoscopic examination. Gong et al BMC Gastroenterol (2021) 21:113 increasingly being recognized in the initial management of patients suspected of having UGIB. Several factors such as presenting with symptoms of hematemesis or melena, a bloody nasogastric aspirate, and laboratory data are known to be useful indicators for UGIB [4]. Various risk stratification schemes, including the Glasgow–Blatchford score (GBS), Rockall score, and AIMS65, have been developed and validated to identify high-risk patients requiring emergency endoscopy [5,6,7,8,9]. Its negative predictive value is low, and the insertion of a nasogastric tube can cause considerable discomfort to the patients [12,13,14]

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