GI Bleed: Is NG lavage indicated?

When a patient presents with GI bleeding, the classical first maneuver was to lavage the stomach.  Upon further review, the literature would seem to indicate that NG lavage is not useful: 

·         American College of Gastroenterology Practice Guidelines 2012

o   NG or OG lavage is not required in patients in UGIB for diagnosis, prognosis, visualization or therapeutic effect. [i]

§  Bloody or coffee ground NG aspirates clearly document upper GI bleed, but a clear of bile-stained aspirate may be seen in up to 18% of patients with upper GI source.

§  Prospective trial with 325 patients, 11% of patients with confirmed UGIB and shock had negative NG aspirate. [ii]

·         NG lavage does not improve mortality, LOS, or transfusion requirements[iii]

o   Retrospective study in Gastrointestinal Endoscopy 2011

§  632 patients with GI bleeding found no statistical difference in 30 day mortality, mean hospital LOS, or transfusion requirements

§  NG lavage was associated to earlier time to endoscopy, but did not change outcomes

·         Visualization

o   Prospective randomized multicenter study published in Annals of Emergency Medicine 2011

§  253 patients, 6 different EDS

§  No difference in visualization during endoscopy between groups receiving IV erythromycin prior to endoscopy vs NGT alone vs NGT + Erythromycin[iv]

§  Therefore, NGT not only option to improve visualization during endoscopy for UGIB

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[i] L. Laine, and D.M. Jensen, "Management of patients with ulcer bleeding.", The American journal of gastroenterology, 2012.

[ii] Lin HJ, Kun W, Perng CL et al. Early or delayed endoscopy for patients with peptic ulcer bleeding: a prospective randomized study. J Clin Gastroenterol 1996;22:267–71.

[iii] E.S. Huang, S. Karsan, F. Kanwal, I. Singh, M. Makhani, and B.M. Spiegel, "Impact of nasogastric lavage on outcomes in acute GI bleeding.", Gastrointestinal endoscopy, 2011.

[iv] D. Pateron et al. "Erythromycin infusion or gastric lavage for upper gastrointestinal bleeding: a multicenter randomized controlled trial.", Annals of emergency medicine, 2011.

from Dr. Felipe Grimaldo