Introduction:

Enteral nutrition is superior to parenteral nutrition in most hospitalized patients and in critical condition for the preservation of intestinal function, due to its low risk and lower cost. There are several devices that facilitate enteral nutrition, one of the most used in Mexico is the Levin-type nasogastric tube, made of plastic, which has been associated with different adverse effects after placement.

Objective:

To describe the endoscopic findings in hospitalized patients referred to upper endoscopy for indication of upper gastrointestinal bleeding (UGIB) who received enteral nutrition by nasogastric tube Levin type.

Material and methods:

We included hospitalized patients, adults of both sexes, who had placed a Levin-type nasogastric tube, and who were referred to upper endoscopy for indication of UGIB between June 2018 and June 2019. For the analysis, descriptive statistics were used, medium and interquartile ranges; frequencies and percentages, as appropriate; and to compare the categorical variables Fisher’s exact test was used. SPSSv21, p <0.05.

Results:

181 upper endoscopies indicated by UGIB were performed in 179 patients; of these, 17 patients (9.4%) had a Levin nasogastric tube placed: 9/17 were men; and the median age was 62 years (IQR 48-67). The duration of the probe was 5 days (IQR 2-9). There was clear bleeding in 15/17 (89%); of which: melena 12/17, vomit with clots 2/17 and hematemesis 1/17. Seven were referred for intensive care. In all patients there were mucosal lesions associated with bleeding. 23.5% (4/17) had a mucosal tear associated directly with the mechanical effect of the tube (p 0.0003, OR 49.5 CI95% 5.2-476); and 58.8% (10/17) had esophagitis due to probable mechanical effect (p 0.000; OR 27.5 CI95% 8.3-91.2). Only 4/17 (23.5%) had anticoagulation with enoxaparin; and 6/17 (35.3%) received transfusion of at least 1 globular package (IQR 1-3). Regarding the endoscopic treatment: 4/17 received argon plasma and/or 3/17 received hemoclips. None of the patients had a 30-day follow-up.

Conclusions:

The nasogastric tube is useful for enteral feeding in hospitalized patients; however, it is associated with important adverse effects such as gastrointestinal hemorrhage. Comparative and cost-effectiveness studies against non-plastic probes are required.

Abbreviations:

IQR, interquartile range, OR, odds ratio.