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

• DOI: 10.1007/s00535-020-01708-5
• Publication Date: 2020-07-15T07:03:46Z
• Authors: 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
• Keywords: Colorectal Surgery; Clinical endpoint

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.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.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.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.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.