Nasogastric Tube Use in Upper GI Bleeding

Indications for NG Tube Placement

The American College of Physicians recommends that nasogastric tube placement be considered selectively for prognostic purposes or to clear the stomach before endoscopy, but it is not routinely recommended for all patients with upper GI bleeding 1
The presence of bright red blood in NG aspirate is an independent predictor of rebleeding and poor outcomes in patients with upper GI bleeding, helping identify patients who need emergency endoscopy 1, 2
Fresh red blood in the nasogastric aspirate predicts increased risk for both rebleeding and mortality in patients with upper GI bleeding 2
NG aspiration confirms an upper GI source when blood is present, which is particularly useful when differentiating upper from lower GI bleeding in patients with hematochezia and hypovolemia 3

Orogastric or nasogastric lavage may be helpful to clear the stomach of blood and clots before endoscopy, potentially improving visualization in patients with upper GI bleeding 1, 2
This is most relevant when very early endoscopy is planned for patients with upper GI bleeding 1

In hemodynamically stable ventilated patients where active upper GI bleeding remains indeterminate, NG lavage should be considered if blood return is shown, according to the American Society for Gastrointestinal Endoscopy 5
NG lavage before upper endoscopy is warranted if there is medium to low suspicion of an upper GI source in patients with severe hematochezia and hypovolemia 3
Blood in the NG tube with bloody stool suggests significant upper GI bleed with brisk bleeding in patients with upper GI bleeding 4

Resuscitation with fluid and blood products always takes precedence and should not be delayed while placing NG tube or pursuing other diagnostic tests in patients with upper GI bleeding 4
Diagnostic nasogastric aspiration is redundant if very early endoscopy is planned for patients with upper GI bleeding, according to the American College of Physicians 1