EM Quick Hits Video on NG Tubes for Bowel Obstruction with Justin Morgenstern

Is there evidence for nasogastric tube placement in management of small bowel obstruction?

  • Nasogastric (NG) tubes are routinely placed in the ED to decompress the stomach when a small bowel obstruction (SBO) is diagnosed; however, there is no good evidence for the routine use of NG tubes in this situation, and they are rated as one of the most painful procedures in EM by patients
  • There are no RCTs looking at the use of NG tubes in SBO; however, observational data suggests worse outcomes with NG tubes than without
    • Fonseca 2013: 290 patients admitted with an SBO, 20% of them were managed without an NG tube. Use of an NG tube resulted in longer time to resolution, longer stay in hospital and higher rates of complications. Non-operative management was successful in 2/3 of patients regardless of NG tube placement
    • Berman 2015: 181 patients admitted with an SBO, 1/2 were managed without an NG tube. No association between use of an NG tube and mortality, surgery or bowel resection. NG tube placement was associated with longer hospital stay
  • Prophylactic NG tubes in post-op ileus is also a common practice; however, a systematic review of 28 studies found that ileus resolved faster in patients without NG tubes

Bottom Line: there is no high-quality evidence for the routine use of NG tubes in SBO. Observational data suggests that routine NG tube placement in SBO and post-op ileus results in worse outcomeEM s. Patients also report that NG tubes are among the most painful procedures done in the ED.

The Podcast: EM Quick Hits 31 – NG Tubes in SBO, Hyperacute T Waves, Malignant Otitis Externa, CCTA, Syncope. Emergency Medicine Cases

In each EM Quick Hits Video, our team hand picks an EM Quick Hits podcast segment and curates a video to enhance you multimodal learning.

Our EM Quick Hits Video team is: Lara Murphy, Yajur Iyengar and Jonathan Whittall