Nasogastric lavage (NGL) seems to be a logical procedure in the evaluation of patients with suspected upper GI bleeding, but does the evidence support the logic? Most studies state that endoscopy should occur within 24 hours of presentation, but the optimal timing within the first 24 hours is unclear. Rebleeding is the greatest predictor of mortality, and these patients benefit from aggressive, early endoscopic hemostatic therapy and/or surgery. So what are the arguments for and against NGL?
The BEST argument for nasogastric lavage:
1. A Positive NGL is Predictive of a High Risk Lesion (PMID: 14745388) :
Now, for the arguments AGAINST nasogastric lavage:
1. It is painful ( PMID: 10339680 ):
2. NGL IS NOT the only way to get good visualization during endoscopy ( PMID: 21333385 ):
3. NGL DOES NOT improve mortality, length of stay, or transfusion requirements ( PMID: 21737077 ):
So what should we say to our gastroenterology colleagues about NGL and UGIB? Well, their own American College of Gastroenterology 2012 guidelines state NGL is not required in patients with UGIB for diagnosis, prognosis, visualization, or therapeutic effect ( PMID: 22310222 ). It looks like there is no dilemma any longer.NG lavage DOES NOT help patients in the emergency department with acute upper GI bleed and is an outdated practice.