Nasogastric tube utilization after esophagectomy: An unnecessary gesture?

Menéndez-Jiménez, M.; Bruna-Esteban, Marcos; Mingol, Fernando; Vaqué, Josep; Hervás, David; Álvarez-Sarrado, Eduardo; Navasquillo-Tamarit, M.; Hurtado-Pardo, Luis; García‐Granero, Eduardo

doi:10.1016/j.cireng.2020.11.011

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…The expert consensus on the perioperative management of patients with free tissue flap reconstruction for head and neck cancer (issued by the Society for Enhanced Recovery after Surgery in 2017 9 ) recommends early resumption of oral feeding after surgery. The benefits of early nasogastric tube removal have been confirmed in patients undergoing surgery for laryngeal cancer and esophageal cancer, 10,11 but there have been few studies in patients with oral cancer. In our study, we designed a nasogastric tube removal plan for two types of patients (those with and without tracheostomy) according to the patients' swallowing function and oral intake, and performed this parallel randomized clinical trial to determine the safety of the methods and their effectiveness in facilitating the early resumption of oral feeding.…”

Section: Introductionmentioning

confidence: 99%

Timing of Oral Feeding in Patients Who have Undergone Free Flap Reconstruction for Oral Cancer

Shan

Cai

et al. 2022

The Laryngoscope

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Objective: Determine the safety and effectiveness of a nasogastric tube removal plan designed to shorten nasogastric tube indwelling time after oral cancer surgery plus free flap reconstruction.Materials and Methods: A parallel randomized clinical trial was conducted from May 2021 to December 2021 at Peking University School of Stomatology. Volunteers (n = 128) were separated into four groups: non-tracheostomy control and intervention groups and tracheostomy control and intervention groups. Control patients received the conventional nasogastric tube removal plan. Non-tracheotomy intervention patients were asked to swallow 5 ml of water on the first postoperative day. If there was no coughing, they were allowed progressively increasing amounts of water for the following 2 days. The nasogastric tube was removed only after ensuring level I/II performance on the Watian water swallowing test, no "wet voice" after drinking water, no marked decrease in blood oxygen saturation after drinking, and satisfactory daily oral nutritional intake. Tracheotomy intervention patients received the same protocol plus an additional Watian water swallowing test after tracheal tube removal.Results: Nasogastric tube removal time was earlier in the intervention subgroups than in control subgroups: 5.0 AE 2.3 days versus 7.8 AE 3.9 days (p = 0.001) in non-tracheostomy patients and 9.8 AE 1.1 days versus 16.2 AE 13.0 days (p = 0.049) in tracheostomy patients. Incidence of wound complications and daily food intake were comparable between the groups. The incidence of pneumonia was lower in the tracheostomy intervention group than in the tracheostomy control group (12.5% vs. 3.1%, p = 0.162). Pharyngeal pain score was lower in tracheotomy intervention patients than in tracheotomy control patients (p = 0.029). Postoperative hospital stay was shorter in tracheotomy intervention patients than in tracheotomy control patients (p = 0.005).Conclusions: On the basis of ensuring safety and effectiveness, patients undergone free flap reconstruction for oral cancer could be offered oral intake early after surgery, which will not increase the incidence of wound complications and pneumonia or adversely affecting the oral intake of the patients; it can also help minimize pharyngeal pain and shorten postoperative hospital stay of patients with a tracheotomy.

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Section: Introductionmentioning

confidence: 99%

Timing of Oral Feeding in Patients Who have Undergone Free Flap Reconstruction for Oral Cancer

Shan

Cai

et al. 2022

The Laryngoscope

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“…At the same time, the development of a reasonable post-operative management plan after endoscopic foreign body removal is also crucial for the treatment of patients. More and more scholars are skeptical about the efficacy of NGT insertion after abdominal surgery [ 11 , 17 ]. There is a lack of data on the necessity for NGT placement in EP caused by a foreign body.…”

Section: Discussionmentioning

confidence: 99%

“…[ 10 ] conducted a retrospective analysis on 62 patients with acute appendicitis perforation; the study showed that the mean time to first oral intake and post-operative length of stay were significantly lower in the non-NGT group than in the NGT group, and thus it was concluded that the routine placement of NGTs is not always necessary. A Spanish study involving 43 patients undergoing esophagectomy concluded that not using NGTs was a safe measure and improved patient comfort and post-operative recovery [ 11 ], whereas no studies have investigated the routine use of NGTs in EP caused by foreign bodies. Hence, we designed this study to investigate the necessity for routine NGT placement in patients with EP after endoscopic foreign body removal so as to provide a reference for clinical application.…”

Section: Introductionmentioning

confidence: 99%

Routine nasogastric tube placement in patients with small esophageal perforation after endoscopic foreign body removal may be unnecessary: a propensity score matching analysis

Liao

Yang

Zhan

et al. 2022

Gastroenterology Report

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Background Nasogastric tube (NGT) placement is part of the post-operative management of upper gastrointestinal perforation, but its routine use in esophageal perforation (EP) caused by foreign bodies remains unclear. The purpose of this research was to investigate the necessity for routine NGT placement in patients with EP after endoscopic foreign body removal. Methods A total of 323 patients diagnosed with EP caused by foreign bodies at the First Affiliated Hospital of Nanchang University between January 2012 and December 2021 were included in this retrospective study. Patients were divided into the NGT group and the non-NGT group according to whether or not NGT placement was performed. The perforation healing rate, post-operative adverse events, hospital stay, and death rate were analysed using a 1:1 propensity score matching model. Results Before matching, there were 263 patients in the NGT group and 60 patients in the non-NGT group. There were significant differences in the time to treatment, infection, albumin, and types of endoscopy between the two groups, while the length of hospital stay in the NGT group was significantly longer than that in the non-NGT group. After 1:1 propensity score matching, 48 pairs of patients were matched between the two groups. The perforation healing rate, post-operative adverse events, length of hospital stay, and death rate did not show significant differences between the two groups. Conclusions For patients with small EP caused by foreign bodies, routine NGT placement after endoscopic foreign body removal may be unnecessary.

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“…Recently, the development of minimally invasive surgery, the improvement of the anesthetic prevention of PONV and rehabilitation protocols have opened a debate about the real need of routine placement of a NGT [27]. There are several studies evaluating the use of the NGT in colorectal, hepatic, urologic, thoracic, otorhinolaryngology, gastric and esophageal surgery [28][29][30][31][32][33][34].…”

Section: Introductionmentioning

confidence: 99%

Nasogastric tube after laparoscopic Heller-Dor myotomy: do you really need it?

Palomba

Basile

Capuano

et al. 2023

Preprint

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Background Achalasia is a rare esophageal motor disorder. Laparoscopic Heller-Dor myotomy (LHD) is among the most effective treatments. The use of nasogastric tube (NGT) following LHD is still controversial. The aim of our study was to evaluate the role of NGT in achalasia patients undergoing LHD. Methods We prospectively enrolled achalasia patients treated with LHD from January 2019 until June 2022 at our institution and randomly assigned them to two groups: one group with NGT and group without (noNGT). Perioperative outcomes were compared between the two groups. ClinicalTrials.gov Identifier: NCT05729971. Results Seventy-nine patients who underwent LHD myotomy were prospectively enrolled. Patients were divided in two groups: 38 with NGT and 41 noNGT. There were no significant differences between two groups in terms of demographic data, preoperative characteristics, length of stay, start of liquid and solid diet, intraoperative and postoperative complications. First flatus was shorter in the noNGT group (p: 0.03). Conclusion Nasogastric tube placement following LHD myotomy does not reduce nausea, vomiting and chest pain, while it increased patients discomfort and time of first flatus.

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Nasogastric tube utilization after esophagectomy: An unnecessary gesture?

Cited by 3 publications

References 25 publications

Timing of Oral Feeding in Patients Who have Undergone Free Flap Reconstruction for Oral Cancer

Timing of Oral Feeding in Patients Who have Undergone Free Flap Reconstruction for Oral Cancer

Routine nasogastric tube placement in patients with small esophageal perforation after endoscopic foreign body removal may be unnecessary: a propensity score matching analysis

Nasogastric tube after laparoscopic Heller-Dor myotomy: do you really need it?

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