BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its...BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its placement are often underes-timated.Upper airway obstruction with a NGT is an uncommon but potentially life-threatening complication.NGT syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually bilateral.It is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway obstruction.However,fewer cases may have been reported than might have occurred,primarily due to the clinicians'unawareness.The lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite challenging.AIM To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway obstruction.METHODS We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://www.referencecitation-analysis.com/)and Google scholar,from all the past studies till August 2023.The search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further prepared.RESULTS Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our search.There was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 years.Ten patients had diabetes mellitus(37.04%),and nine were hypertensive(33.33%).Only three(11.11%)patients were reported to be immunocompromised.The median time for developing symptoms after NGT insertion was 14.5 d(interquartile range 6.25-33.75 d).The most commonly reported reason for NGT insertion was acute stroke(10,37.01%)and the most commonly reported symptoms were stridor or wheezing 17(62.96%).In 77.78%of cases,bilateral VC were affected.The only treatment instituted in most patients(77.78%)was removing the NG tube.Most patients(62.96%)required tracheostomy for airway protection.But 8 of the 23 survivors recovered within five weeks and could be decannulated.Three patients were reported to have died.CONCLUSION NGT syndrome is an uncommon clinical complication of a very common clinical procedure.However,an under-reporting is possible because of misdiagnosis or lack of awareness among clinicians.Patients in early stages and with mild symptoms may be missed.Further,high variability in the presentation timing after NGT insertion makes diagnosis challenging.Early diagnosis and prompt removal of NGT may suffice in most patients,but a significant proportion of patients presenting with respiratory compromise may require tracheostomy for airway protection.展开更多
Transnasal intubation is a clinical operation usually performed blindly at the bedside.Mild adverse events,such as epistaxis and tube misplacement,are relatively common.Esophageal bleeding or perforation and other ser...Transnasal intubation is a clinical operation usually performed blindly at the bedside.Mild adverse events,such as epistaxis and tube misplacement,are relatively common.Esophageal bleeding or perforation and other serious adverse events are rare.In the present study,two cases of severe diffuse esophageal bleeding caused by the blind placement of a nasogastric tube are described.These cases were successfully treated using a covered metal stent or Sengstaken-Blakemore tube.A review of the literature regarding the possible causes of such adverse events and the potential endoscopic treatments for severe hemorrhage are discussed.展开更多
BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the ...BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the success rates,insertion time and complications associated with different techniques of NGT insertion in anesthetized and intubated patients.METHODS An electronic search of the PubMed,Scopus,CENTRAL(Cochrane Central Register of Controlled Trials),and Google Scholar databases were performed up to October 31,2019.We included 17 randomized controlled trials with 2500 participants in the meta-analysis.RESULTS As compared to the conventional method,successful insertion of the NGT on first attempt was higher with modified techniques such as the reverse Sellick’s maneuver[relative risk(RR)1.94;95%confidence interval(CI):1.62-2.31],use of a frozen NGT(RR 1.55;95%CI:1.13-2.13),inserting the NGT with neck flexion and lateral neck pressure(RR 1.64;95%CI:1.10-2.45),endotracheal tube-assisted(RR 1.88;95%CI:1.52-2.32)and video-assisted placements(RR 1.60;95%CI:1.31-1.95).All the modified techniques also led to comparatively higher insertion success rates than the conventional technique.CONCLUSION The use of modified techniques of NGT insertion such as the reverse Sellick’s maneuver,neck flexion with lateral neck pressure,frozen NGT,endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique.All modified techniques also significantly improve the overall chance of successful NGT placement as compared to the conventional method.展开更多
BACKGROUND The indwelling nasogastric tube is commonly used for supplying enteral nutrition to patients who are unable to feed themselves,and accurate positioning is essential in the indwelling nasogastric tube in the...BACKGROUND The indwelling nasogastric tube is commonly used for supplying enteral nutrition to patients who are unable to feed themselves,and accurate positioning is essential in the indwelling nasogastric tube in the body of the aforementioned patients.In clinical practice,abdominal radiography,auscultation,and clinical determination of the pH of the gastric juice are routinely used by medical personnel to determine the position of the tube;however,those treatments have proved limitations in specific cases.There are few case reports on the precise positioning of the nasogastric tube in patients with coronavirus disease 2019(COVID-19),for whom a supply of necessary nutrition support is significant throughout the process of treatment.CASE SUMMARY A 79-year-old patient,diagnosed with COVID-19 at the stage of combined syndromes with severe bacterial lung infection,respiratory failure,multiple comorbidities,and a poor nutritional status,was presented to us and required an indwelling nasogastric tube for enteral nutrition support.After pre-treatment assessments including observation of the patient’s nasal feeding status and examination of the nasal septal deviation,inflammation,obstruction,nasal leakage of cerebrospinal fluid,and other disorders that might render intubation inappropriate,we measured and marked the length of the nasogastric tube to be placed and delivered the tube to the intended length in the standard manner.Then further scrutiny was conducted to ensure that the tube was not coiled in the mouth,and gentle movements were made to avoid damage to the esophageal mucosa.However,back draw of the gastric juice using an empty needle failed,and the stethoscope could not be used for auscultation due to the specific condition presented by the internal organs of the patient,and the end of the tube was placed in saline with no bubbles spilling out.Therefore,it was not possible to determine whether the nasogastric tube was placed exactly in the stomach and no nutrient infusion was performed for the time being.Subsequently,the ultrasound probe was utilized to view the condition of the patient’s stomach,where the nasogastric tube was found to be translucent and running parallel to the esophagus shaped as“=”.The pre-conditions were achieved and 100 mL nutritional fluid was fed to the patient,who did not experience any discomfort throughout the procedure.His vital signs were stable with no adverse effects.CONCLUSION We achieved successfully used ultrasound to position the nasogastric tube in a 79-year-old patient with COVID-19.The repeatable ultrasound application does not involve radiation and causes less disturbance in the neck,making it advantageous for rapid positioning of the nasogastric tube and worthy of clinical promotion and application.展开更多
Nasogastric tube is widely used in intensive care units. The complications of misplacement are rare but very dangerous for critically ill patients. Accurate localization of the position of the tip of nasogastric tube ...Nasogastric tube is widely used in intensive care units. The complications of misplacement are rare but very dangerous for critically ill patients. Accurate localization of the position of the tip of nasogastric tube can effectively decrease complications and ensure the safety of critically ill patients. There are various methods that can be used to verify the location of the nasogastric tube such as radiography, PH measurement, electromagnetic navigator and ultrasound. However, there is a lack of general consensus regarding a standard method. In this review, we found that the accuracy of nasogastric tube placement can be greatly improved by visual technology such as X-ray, sonography and electromagnetic navigator. However, visual technology has not been widely used to locate the tip of nasogastric tube in critically ill patients. Best practice guidelines based on the available knowledge and evidence of current methods are necessary to increase the accuracy placement of nasogastric tube. It is envisioned that development of visual technologies will determine a new standard of care for verification of placement of nasogastric tube.展开更多
Background:Nasogastric tube(NGT)placement is part of the post-operative management of upper gastrointestinal perforation,but its routine use in esophageal perforation(EP)caused by foreign bodies remains unclear.The pu...Background:Nasogastric tube(NGT)placement is part of the post-operative management of upper gastrointestinal perforation,but its routine use in esophageal perforation(EP)caused by foreign bodies remains unclear.The purpose of this research was to investigate the necessity for routine NGT placement in patients with EP after endoscopic foreign body removal.Methods:A total of 323 patients diagnosed with EP caused by foreign bodies at the First Affiliated Hospital of Nanchang University between January 2012 and December 2021 were included in this retrospective study.Patients were divided into the NGT group and the non-NGT group according to whether or not NGT placement was performed.The perforation healing rate,post-operative adverse events,hospital stay,and death rate were analysed using a 1:1 propensity score matching model.Results:Before matching,there were 263 patients in the NGT group and 60 patients in the non-NGT group.There were significant differences in the time to treatment,infection,albumin,and types of endoscopy between the two groups,while the length of hospital stay in the NGT group was significantly longer than that in the non-NGT group.After 1:1 propensity score matching,48 pairs of patients were matched between the two groups.The perforation healing rate,post-operative adverse events,length of hospital stay,and death rate did not show significant differences between the two groups.Conclusions:For patients with small EP caused by foreign bodies,routine NGT placement after endoscopic foreign body removal may be unnecessary.展开更多
ObjectiveTo compare the effects of oral intake and nasogastric tube(NG)feeding on nutritional status,complications and survival during neoadjuvant chemoradiotherapy for esophageal squamous-cell carcinoma(ESCC)patients...ObjectiveTo compare the effects of oral intake and nasogastric tube(NG)feeding on nutritional status,complications and survival during neoadjuvant chemoradiotherapy for esophageal squamous-cell carcinoma(ESCC)patients.MethodsA total of 61 ESCC cases treated with neoadjuvant chemoradiotherapy from December 2018 to March 2020 were enrolled,including(38 in oral intake group,and 22 in NG feeding group.Disease characteristics and baseline nutritional markers were collected in both groups.Nutritional status,complication and completion rate of chemoradiotherapy in both groups were evaluated.ResultsCompared with the oral intake group,patients in the NG feeding group had a later T stage(P=0.027)and clinical stage(P=0.014).The levels of energy intake(P=0.033),serum prealbumin(P<0.001),albumin(P=0.017)and hemoglobin(P=0.015)before treatment in NG group were significantly lower than those in oral intake group.Furthermore,patient-generated subjective global assessment(PG-SGA)score(P=0.016)and the levels of serum C-reactive protein(P=0.014)of NG feeding group were significantly higher than those of oral intake group.However,at the end of treatment,PG-SGA scores were increased in oral intake group and decreased in NG feeding group.In addition,the NG feeding group had a lower incidence of grade≥2 esophagitis(P=0.037),and higher completion rate of chemotherapy compared with oral intake group(P=0.034).Meanwhile,the proportion of parenteral nutrition(P=0.008)and anti-inflammatory(P=0.022)treatment in NG feeding group was significantly lower than that in oral intake group.Although patients in the NG feeding group had a worse prognosis,there were no statistically significant differences in overall survival(OS)and progression-free survival(PFS)between the two groups(P>0.05).ConclusionsAs a safe and effective enteral nutrition approach to improving nutrition,nasogastric tube feeding could increase treatment completion rate and reduce the incidence of≥grade 2 esophagitis reaction during neoadjuvant chemoradiotherapy.展开更多
Importance A nasogastric tube is used commonly to decompress the stomach and provide enteral feeding in surgical and medical practice.Sometimes this safe and innocent‐looking tube may lead to unexpected complications...Importance A nasogastric tube is used commonly to decompress the stomach and provide enteral feeding in surgical and medical practice.Sometimes this safe and innocent‐looking tube may lead to unexpected complications.We focus here on the possibility of spontaneous‘lariat loop’knotting of the nasogastric tube when some resistance is felt on tube retrieval and describe a method of safe tube removal.Case presentation We present a case of self‐knotting of a nasogastric tube that was placed to decompress the stomach during the postoperative period after surgical repair of anorectal malformation in a 4‐month‐old boy.Conclusion Self‐knotting of the distal end of nasogastric tube is an unusual complication with catastrophic sequelae if not addressed properly.If any resistance is felt during nasogastric tube retrieval,self‐knotting of the tube must be suspected.展开更多
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRSHIPEC)has shown promising results in improving the survival of ovarian cancer patients.Although the safety profiles of CRS-HIPEC exist,...BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRSHIPEC)has shown promising results in improving the survival of ovarian cancer patients.Although the safety profiles of CRS-HIPEC exist,more attention should be paid to gastrointestinal complications,as the procedure involves a considerable proportion of bowel resection and anastomosis.AIM To identify the risk factors for delayed gastric emptying in ovarian cancer treated with CRS-HIPEC.METHODS A cross-sectional study was conducted.According to the inclusion and exclusion criteria,we retrospectively analyzed 77 patients admitted between March 2014 and April 2018 with advanced and recurrent ovarian cancer treated with CRSHIPEC in Beijing Shijitan Hospital of Capital Medical University.Risk factors for delayed gastric emptying were analyzed using univariate analysis.All of the statistically significant variables in the univariate analysis were entered into the multivariable logistic regression model to determine factors independently associated with delayed gastric emptying.RESULTS Among the 77 included patients,36.4%(28/77)had delayed gastric emptying after CRS-HIPEC.The median age and body mass index of all patients were 59 years and 22.83 kg/m^(2),respectively.Preoperative chemotherapy was administered in 55 patients(71%).Sixty-two patients(81%)had a history of at least one previous pelvic surgery.The median operation time and intraoperative hemorrhage volume were 630 min and 600 mL,respectively.Omentectomy was performed in 32 cases of primary ovarian cancer and 24 cases of recurrence.The median peritoneal cancer index was 16.The risk factors for delayed gastric emptying from the univariate analysis were body mass index<23 kg/m2(X2=5.059,P=0.025),history of pelvic surgery(X^(2)=4.498,P=0.034),history of chemotherapy(X^(2)=4.334,P=0.037),operation time≥7 h(X2=4.827,P=0.047),and intraoperative hemorrhage≥800 mL(X^(2)=7.112,P=0.008).Multivariable analysis revealed that age≥70 years(HR=7.127;95%CI 1.122-45.264;P=0.037)and intraoperative hemorrhage≥800 mL(HR=3.416;95%CI 1.067-10.939;P=0.039)were independently associated with postoperative delayed gastric emptying after CRS-HIPEC.CONCLUSION Postoperative gastrointestinal management,including prolonged nasogastric intubation,should be promoted for patients over 70 years or those with intraoperative bleeding exceeding 800 mL.展开更多
文摘BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its placement are often underes-timated.Upper airway obstruction with a NGT is an uncommon but potentially life-threatening complication.NGT syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually bilateral.It is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway obstruction.However,fewer cases may have been reported than might have occurred,primarily due to the clinicians'unawareness.The lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite challenging.AIM To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway obstruction.METHODS We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://www.referencecitation-analysis.com/)and Google scholar,from all the past studies till August 2023.The search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further prepared.RESULTS Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our search.There was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 years.Ten patients had diabetes mellitus(37.04%),and nine were hypertensive(33.33%).Only three(11.11%)patients were reported to be immunocompromised.The median time for developing symptoms after NGT insertion was 14.5 d(interquartile range 6.25-33.75 d).The most commonly reported reason for NGT insertion was acute stroke(10,37.01%)and the most commonly reported symptoms were stridor or wheezing 17(62.96%).In 77.78%of cases,bilateral VC were affected.The only treatment instituted in most patients(77.78%)was removing the NG tube.Most patients(62.96%)required tracheostomy for airway protection.But 8 of the 23 survivors recovered within five weeks and could be decannulated.Three patients were reported to have died.CONCLUSION NGT syndrome is an uncommon clinical complication of a very common clinical procedure.However,an under-reporting is possible because of misdiagnosis or lack of awareness among clinicians.Patients in early stages and with mild symptoms may be missed.Further,high variability in the presentation timing after NGT insertion makes diagnosis challenging.Early diagnosis and prompt removal of NGT may suffice in most patients,but a significant proportion of patients presenting with respiratory compromise may require tracheostomy for airway protection.
基金This work was supported by the Natural Science Foundation of Fujian Province(grant 2020 J01974)Special Scientific Research Funds of Fujian Provincial Department of Finance(grant 22SCZZX012).
文摘Transnasal intubation is a clinical operation usually performed blindly at the bedside.Mild adverse events,such as epistaxis and tube misplacement,are relatively common.Esophageal bleeding or perforation and other serious adverse events are rare.In the present study,two cases of severe diffuse esophageal bleeding caused by the blind placement of a nasogastric tube are described.These cases were successfully treated using a covered metal stent or Sengstaken-Blakemore tube.A review of the literature regarding the possible causes of such adverse events and the potential endoscopic treatments for severe hemorrhage are discussed.
文摘BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the success rates,insertion time and complications associated with different techniques of NGT insertion in anesthetized and intubated patients.METHODS An electronic search of the PubMed,Scopus,CENTRAL(Cochrane Central Register of Controlled Trials),and Google Scholar databases were performed up to October 31,2019.We included 17 randomized controlled trials with 2500 participants in the meta-analysis.RESULTS As compared to the conventional method,successful insertion of the NGT on first attempt was higher with modified techniques such as the reverse Sellick’s maneuver[relative risk(RR)1.94;95%confidence interval(CI):1.62-2.31],use of a frozen NGT(RR 1.55;95%CI:1.13-2.13),inserting the NGT with neck flexion and lateral neck pressure(RR 1.64;95%CI:1.10-2.45),endotracheal tube-assisted(RR 1.88;95%CI:1.52-2.32)and video-assisted placements(RR 1.60;95%CI:1.31-1.95).All the modified techniques also led to comparatively higher insertion success rates than the conventional technique.CONCLUSION The use of modified techniques of NGT insertion such as the reverse Sellick’s maneuver,neck flexion with lateral neck pressure,frozen NGT,endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique.All modified techniques also significantly improve the overall chance of successful NGT placement as compared to the conventional method.
基金Supported by Chongqing Medical Scientific Research Project,No.2020FYYX046。
文摘BACKGROUND The indwelling nasogastric tube is commonly used for supplying enteral nutrition to patients who are unable to feed themselves,and accurate positioning is essential in the indwelling nasogastric tube in the body of the aforementioned patients.In clinical practice,abdominal radiography,auscultation,and clinical determination of the pH of the gastric juice are routinely used by medical personnel to determine the position of the tube;however,those treatments have proved limitations in specific cases.There are few case reports on the precise positioning of the nasogastric tube in patients with coronavirus disease 2019(COVID-19),for whom a supply of necessary nutrition support is significant throughout the process of treatment.CASE SUMMARY A 79-year-old patient,diagnosed with COVID-19 at the stage of combined syndromes with severe bacterial lung infection,respiratory failure,multiple comorbidities,and a poor nutritional status,was presented to us and required an indwelling nasogastric tube for enteral nutrition support.After pre-treatment assessments including observation of the patient’s nasal feeding status and examination of the nasal septal deviation,inflammation,obstruction,nasal leakage of cerebrospinal fluid,and other disorders that might render intubation inappropriate,we measured and marked the length of the nasogastric tube to be placed and delivered the tube to the intended length in the standard manner.Then further scrutiny was conducted to ensure that the tube was not coiled in the mouth,and gentle movements were made to avoid damage to the esophageal mucosa.However,back draw of the gastric juice using an empty needle failed,and the stethoscope could not be used for auscultation due to the specific condition presented by the internal organs of the patient,and the end of the tube was placed in saline with no bubbles spilling out.Therefore,it was not possible to determine whether the nasogastric tube was placed exactly in the stomach and no nutrient infusion was performed for the time being.Subsequently,the ultrasound probe was utilized to view the condition of the patient’s stomach,where the nasogastric tube was found to be translucent and running parallel to the esophagus shaped as“=”.The pre-conditions were achieved and 100 mL nutritional fluid was fed to the patient,who did not experience any discomfort throughout the procedure.His vital signs were stable with no adverse effects.CONCLUSION We achieved successfully used ultrasound to position the nasogastric tube in a 79-year-old patient with COVID-19.The repeatable ultrasound application does not involve radiation and causes less disturbance in the neck,making it advantageous for rapid positioning of the nasogastric tube and worthy of clinical promotion and application.
文摘Nasogastric tube is widely used in intensive care units. The complications of misplacement are rare but very dangerous for critically ill patients. Accurate localization of the position of the tip of nasogastric tube can effectively decrease complications and ensure the safety of critically ill patients. There are various methods that can be used to verify the location of the nasogastric tube such as radiography, PH measurement, electromagnetic navigator and ultrasound. However, there is a lack of general consensus regarding a standard method. In this review, we found that the accuracy of nasogastric tube placement can be greatly improved by visual technology such as X-ray, sonography and electromagnetic navigator. However, visual technology has not been widely used to locate the tip of nasogastric tube in critically ill patients. Best practice guidelines based on the available knowledge and evidence of current methods are necessary to increase the accuracy placement of nasogastric tube. It is envisioned that development of visual technologies will determine a new standard of care for verification of placement of nasogastric tube.
基金support provided by Jiangxi Clinical Research Center for Gastroenterology(20201ZDG02007).
文摘Background:Nasogastric tube(NGT)placement is part of the post-operative management of upper gastrointestinal perforation,but its routine use in esophageal perforation(EP)caused by foreign bodies remains unclear.The purpose of this research was to investigate the necessity for routine NGT placement in patients with EP after endoscopic foreign body removal.Methods:A total of 323 patients diagnosed with EP caused by foreign bodies at the First Affiliated Hospital of Nanchang University between January 2012 and December 2021 were included in this retrospective study.Patients were divided into the NGT group and the non-NGT group according to whether or not NGT placement was performed.The perforation healing rate,post-operative adverse events,hospital stay,and death rate were analysed using a 1:1 propensity score matching model.Results:Before matching,there were 263 patients in the NGT group and 60 patients in the non-NGT group.There were significant differences in the time to treatment,infection,albumin,and types of endoscopy between the two groups,while the length of hospital stay in the NGT group was significantly longer than that in the non-NGT group.After 1:1 propensity score matching,48 pairs of patients were matched between the two groups.The perforation healing rate,post-operative adverse events,length of hospital stay,and death rate did not show significant differences between the two groups.Conclusions:For patients with small EP caused by foreign bodies,routine NGT placement after endoscopic foreign body removal may be unnecessary.
文摘ObjectiveTo compare the effects of oral intake and nasogastric tube(NG)feeding on nutritional status,complications and survival during neoadjuvant chemoradiotherapy for esophageal squamous-cell carcinoma(ESCC)patients.MethodsA total of 61 ESCC cases treated with neoadjuvant chemoradiotherapy from December 2018 to March 2020 were enrolled,including(38 in oral intake group,and 22 in NG feeding group.Disease characteristics and baseline nutritional markers were collected in both groups.Nutritional status,complication and completion rate of chemoradiotherapy in both groups were evaluated.ResultsCompared with the oral intake group,patients in the NG feeding group had a later T stage(P=0.027)and clinical stage(P=0.014).The levels of energy intake(P=0.033),serum prealbumin(P<0.001),albumin(P=0.017)and hemoglobin(P=0.015)before treatment in NG group were significantly lower than those in oral intake group.Furthermore,patient-generated subjective global assessment(PG-SGA)score(P=0.016)and the levels of serum C-reactive protein(P=0.014)of NG feeding group were significantly higher than those of oral intake group.However,at the end of treatment,PG-SGA scores were increased in oral intake group and decreased in NG feeding group.In addition,the NG feeding group had a lower incidence of grade≥2 esophagitis(P=0.037),and higher completion rate of chemotherapy compared with oral intake group(P=0.034).Meanwhile,the proportion of parenteral nutrition(P=0.008)and anti-inflammatory(P=0.022)treatment in NG feeding group was significantly lower than that in oral intake group.Although patients in the NG feeding group had a worse prognosis,there were no statistically significant differences in overall survival(OS)and progression-free survival(PFS)between the two groups(P>0.05).ConclusionsAs a safe and effective enteral nutrition approach to improving nutrition,nasogastric tube feeding could increase treatment completion rate and reduce the incidence of≥grade 2 esophagitis reaction during neoadjuvant chemoradiotherapy.
文摘Importance A nasogastric tube is used commonly to decompress the stomach and provide enteral feeding in surgical and medical practice.Sometimes this safe and innocent‐looking tube may lead to unexpected complications.We focus here on the possibility of spontaneous‘lariat loop’knotting of the nasogastric tube when some resistance is felt on tube retrieval and describe a method of safe tube removal.Case presentation We present a case of self‐knotting of a nasogastric tube that was placed to decompress the stomach during the postoperative period after surgical repair of anorectal malformation in a 4‐month‐old boy.Conclusion Self‐knotting of the distal end of nasogastric tube is an unusual complication with catastrophic sequelae if not addressed properly.If any resistance is felt during nasogastric tube retrieval,self‐knotting of the tube must be suspected.
基金Supported by Beijing Natural Science Foundation,No.7202075 and“Beijing Hospitals Authority”Ascent Plan,No.DFL20190701.
文摘BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRSHIPEC)has shown promising results in improving the survival of ovarian cancer patients.Although the safety profiles of CRS-HIPEC exist,more attention should be paid to gastrointestinal complications,as the procedure involves a considerable proportion of bowel resection and anastomosis.AIM To identify the risk factors for delayed gastric emptying in ovarian cancer treated with CRS-HIPEC.METHODS A cross-sectional study was conducted.According to the inclusion and exclusion criteria,we retrospectively analyzed 77 patients admitted between March 2014 and April 2018 with advanced and recurrent ovarian cancer treated with CRSHIPEC in Beijing Shijitan Hospital of Capital Medical University.Risk factors for delayed gastric emptying were analyzed using univariate analysis.All of the statistically significant variables in the univariate analysis were entered into the multivariable logistic regression model to determine factors independently associated with delayed gastric emptying.RESULTS Among the 77 included patients,36.4%(28/77)had delayed gastric emptying after CRS-HIPEC.The median age and body mass index of all patients were 59 years and 22.83 kg/m^(2),respectively.Preoperative chemotherapy was administered in 55 patients(71%).Sixty-two patients(81%)had a history of at least one previous pelvic surgery.The median operation time and intraoperative hemorrhage volume were 630 min and 600 mL,respectively.Omentectomy was performed in 32 cases of primary ovarian cancer and 24 cases of recurrence.The median peritoneal cancer index was 16.The risk factors for delayed gastric emptying from the univariate analysis were body mass index<23 kg/m2(X2=5.059,P=0.025),history of pelvic surgery(X^(2)=4.498,P=0.034),history of chemotherapy(X^(2)=4.334,P=0.037),operation time≥7 h(X2=4.827,P=0.047),and intraoperative hemorrhage≥800 mL(X^(2)=7.112,P=0.008).Multivariable analysis revealed that age≥70 years(HR=7.127;95%CI 1.122-45.264;P=0.037)and intraoperative hemorrhage≥800 mL(HR=3.416;95%CI 1.067-10.939;P=0.039)were independently associated with postoperative delayed gastric emptying after CRS-HIPEC.CONCLUSION Postoperative gastrointestinal management,including prolonged nasogastric intubation,should be promoted for patients over 70 years or those with intraoperative bleeding exceeding 800 mL.
