How is nasogastric lavage visualization improved for the assessment of upper GI bleeding (UGIB)?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

The standard small 16-18 gauge nasogastric tube typically used for aspiration is not likely to effectively clear clots from the stomach, despite vigorous lavage. A large-bore orogastric tube is more likely to be successful in clearing the stomach, but the use of a large-bore orogastric tube is difficult and uncomfortable for patients and cannot be recommended routinely.

With regard to therapeutic effect, older surgical literature reported that nasogastric lavage could stop bleeding in a majority of cases and also recommended the use of iced saline. However, UGIB stops spontaneously in most patients without specific therapy, and canine studies with experimentally induced ulcers have indicated that results with lavage are no better, and may even be worse, at temperatures of 0°-4°C (32°-39.2°F) [65] as a result of disruption of the clotting cascade. Patients are invariably uncomfortable with nasogastric tubes in general and often are uncomfortably chilled with cold lavage attempts.


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