Who would avoid severe adverse events from nasointestinal tube in small bowel obstruction? A matched case-control study

Abstract

Background: Nasointestinal tubes (NITs) have been increasingly used in patients with small bowel obstruction (SBO); However, severe adverse events (SAEs) of NITs might threaten the lives of patients. The indications of NITs need to be identified. This study was designed to explore the indications for the insertion of NITs in patients with SBO and to suggest the optimal strategies for individuals based on the outcomes of SAEs.

Methods: After propensity score matching, 68 pairs were included (Success group and failure group). The occurrence of SAEs and the clinical parameters were compared between the SAE group and the non-SAE group. Independent risk factors were evaluated among the subgroups. A novel scoring system was established to detect the subgroups that would benefit from NITs insertion.

Results: Successful implementation of NITs could avoid hypochloremia (p = 0.010), SAEs (p = 0.001), pneumonia (p = 0.006). SAEs occurred in 13 of 136 (9.6%) patients who accepted NITs insertion treatment. Risk factors for SAEs included tumors (p = 0.002), reduced BMI (p = 0.048), reduced hemoglobin (p = 0.001), abnormal activated partial thromboplastin time (p = 0.015) and elevated white blood cells (p = 0.002). A novel risk scoring system consists of hemoglobin before NITs insertion (95% CI 0.685, 0.893) and bowel obstruction symptoms relieved after NITs insertion (95% CI 0.575, 0.900) had the highest area under curve for predicting the occurrence of SAEs. We divided the risk score system into 3 grades, with the increasing grades, the rates of SAEs surged from 1.3% (1/74) to (6/11) 54.5%.

Conclusion: NITs successfully insertion could avoid SAEs occurrence in SBO conservative treatment. SBO patients without anemia and could be relieved after NITs insertion could be the potential benefit group for this therapy.

Keywords: Indication; Nasointestinal tube; Risk score system; Severe adverse events; Small bowel obstruction.

Fig. 1

The workflow of this study

Fig. 2

CT image of a patient with adhesive ileus with successful decompression after NIT insertion. A Before NIT insertion; B X—ray of completion of NIT insertion; C Three days after NIT insertion

Fig. 3

CT image of a patient with malignancy ileus who failed to decompress after NIT insertion. A Before NIT insertion(at the arrow is a tumor); B X—ray of completion of NIT insertion; C Three days after NIT insertion

Fig. 4

The ROC curve of abdominal pain or distension being relieved after NIT insertion, low hemoglobin before NIT insertion and ‘score’

Fig. 5

The nomogram of risk factors

Fig. 6

CT image of patient with SAE in the success group. A the first day postoperation, bowel expansion; B the day before tubes placement, after thirteen days medicine treatment, the bowel is still dilated; C tubes insertion; D two days after tube insertion(at the arrow is subphrenic free air)