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15.07.2020 | Original Article–Alimentary Tract | Ausgabe 9/2020

Journal of Gastroenterology 9/2020

The first management using intubation of a nasogastric tube with Gastrografin enterography or long tube for non-strangulated acute small bowel obstruction: a multicenter, randomized controlled trial

Zeitschrift:
Journal of Gastroenterology > Ausgabe 9/2020
Autoren:
Takahito Katano, Takaya Shimura, Hirotada Nishie, Tomohiro Iwai, Keisuke Itoh, Masahide Ebi, Yusuke Mizuno, Shozo Togawa, Shunsuke Shibata, Tomonori Yamada, Takashi Mizushima, Yusuke Inagaki, Mika Kitagawa, Yu Nojiri, Yoshito Tanaka, Yasuyuki Okamoto, Miyuki Sugiura, Sho Matoya, Yoshihito Nagura, Yuki Inagaki, Hiroki Koguchi, Satoshi Ono, Keiji Ozeki, Noriyuki Hayashi, Shuji Takiguchi, Hiromi Kataoka
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00535-020-01708-5) contains supplementary material, which is available to authorized users.

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Abstract

Background

Gastrointestinal decompression is generally applied to a non-strangulated acute small bowel obstruction (NSASBO). Although long tube (LT) placement and administration of Gastrografin through a nasogastric tube (NGT-G) have shown advantages over NGT alone in previous studies, no studies appear to have compared LT and NGT-G.

Methods

In this multicenter, randomized controlled trial, patients with NSASBO were randomly assigned to receive LT or NGT-G between July 2016 and November 2018 at 11 Japanese institutions. The primary endpoint was non-inferiority of NGT-G compared to LT for non-surgery rate, and the lower limit of the 95% confidence interval for the non-surgery rate (−15%) was set as the lower margin for inferiority of NGT-G compared to LT.

Results

In total, 223 patients (LT group, n = 111; NGT-G group, n = 112) were analyzed in the present trial. The non-surgery rate was 87.4% in the LT group and 91.1% in the NGT-G group, with a 3.7% difference between NGT-G and LT (95.3%CI − 5.55 to 12.91; non-inferiority P = 0.00002923). On the other hand, the non-surgery rate with pure NGT-G alone (76.8%) that represents non-cross-over NGT-G without subsequent LT was significantly lower than that with LT (P = 0.039). Median procedure time was significantly shorter with NGT-G (1 min) than with LT (25 min; P < 0.001), whereas no significant differences in mortality or hospital stay were noted between groups.

Conclusion

NGT-G is an effective alternative to LT as a first-line treatment for NSASBO. A sequential strategy comprising NGT-G followed by LT might offer a new standard for NSASBO.

Clinical trials registration

This trial was registered with the University Hospital Medical Information Network Clinical Trials Registry (umin.ac.jp/ctr Identifier: UMIN000022669) prior to the start of this trial.

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