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Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes

Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes
Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes
Background: Over 1500 patients with oesophageal cancer undergo a resection in the UK each year. At surgery, patients commonly have a nasogastric tube (NGT) placed and may undergo a pyloric intervention. There is conflicting evidence on the use of both NGTs and pyloric interventions during oesophageal resections. We performed a national survey of oesophageal centres and assessed practice variation.

Material and methods: An electronic survey was distributed to all resection centres in England, Wales and Scotland. Variations in practice regarding NGTs and pyloric intervention were assessed, and compared to nationally reported centre volumes and length-of-stay data.

Results: Most centres (31/39, 79%) responded to the survey. All centres reported routine NGT use. The majority of centres (19/31, 61%) did not perform pyloric interventions. When used, surgical pyloroplasty was the most frequent strategy (8/31, 26%). Routine post-operative radiological assessment was utilised in 9/31 (29%) of centres. Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different protocols. There were no significant differences in practice between high and low volume centres. There were also no trends seen when comparing centres above vs at-or-below the median length-of-stay. The majority (68%) of centres were willing to take part in a trial assessing NGT use and pyloric interventions.

Conclusions: Pyloric intervention use varies widely, with no clear link to outcomes. NGT use remains standard practice despite evidence for safe omission. Surgeons require and recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection.
Delayed gastric emptying, Enhanced recovery, Nasogastric tube, Oesophageal cancer, Oesophagectomy, Pyloric intervention
0748-7983
1033-1038
Bull, Alexander
843df257-a845-4e0c-b656-36ea942ad601
Pucher, Philip H
88d1340c-f1df-448d-a816-84fdefca48a1
Maynard, Nick
31c5af9f-6d48-471e-b345-fe4eca62af4f
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Lagergren, Jesper
5f9eb436-72f1-4b7f-949d-4e4e23aecdc9
Gossage, James A
119f99b9-8127-4ae4-a283-8a735edec603
Bull, Alexander
843df257-a845-4e0c-b656-36ea942ad601
Pucher, Philip H
88d1340c-f1df-448d-a816-84fdefca48a1
Maynard, Nick
31c5af9f-6d48-471e-b345-fe4eca62af4f
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Lagergren, Jesper
5f9eb436-72f1-4b7f-949d-4e4e23aecdc9
Gossage, James A
119f99b9-8127-4ae4-a283-8a735edec603

Bull, Alexander, Pucher, Philip H, Maynard, Nick, Underwood, Timothy, Lagergren, Jesper and Gossage, James A (2022) Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes. European Journal of Surgical Oncology, 48 (5), 1033-1038. (doi:10.1016/j.ejso.2021.11.125).

Record type: Article

Abstract

Background: Over 1500 patients with oesophageal cancer undergo a resection in the UK each year. At surgery, patients commonly have a nasogastric tube (NGT) placed and may undergo a pyloric intervention. There is conflicting evidence on the use of both NGTs and pyloric interventions during oesophageal resections. We performed a national survey of oesophageal centres and assessed practice variation.

Material and methods: An electronic survey was distributed to all resection centres in England, Wales and Scotland. Variations in practice regarding NGTs and pyloric intervention were assessed, and compared to nationally reported centre volumes and length-of-stay data.

Results: Most centres (31/39, 79%) responded to the survey. All centres reported routine NGT use. The majority of centres (19/31, 61%) did not perform pyloric interventions. When used, surgical pyloroplasty was the most frequent strategy (8/31, 26%). Routine post-operative radiological assessment was utilised in 9/31 (29%) of centres. Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different protocols. There were no significant differences in practice between high and low volume centres. There were also no trends seen when comparing centres above vs at-or-below the median length-of-stay. The majority (68%) of centres were willing to take part in a trial assessing NGT use and pyloric interventions.

Conclusions: Pyloric intervention use varies widely, with no clear link to outcomes. NGT use remains standard practice despite evidence for safe omission. Surgeons require and recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection.

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NGT - modernisation and standardisation - EJSO - Accepted Manuscript
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More information

Submitted date: 5 July 2021
Accepted/In Press date: 20 November 2021
e-pub ahead of print date: 22 November 2021
Published date: 1 May 2022
Additional Information: Publisher Copyright: © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
Keywords: Delayed gastric emptying, Enhanced recovery, Nasogastric tube, Oesophageal cancer, Oesophagectomy, Pyloric intervention

Identifiers

Local EPrints ID: 450541
URI: http://eprints.soton.ac.uk/id/eprint/450541
ISSN: 0748-7983
PURE UUID: d0a8e72c-3c8e-4a45-9380-40fa1166bb19
ORCID for Timothy Underwood: ORCID iD orcid.org/0000-0001-9455-2188

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Date deposited: 03 Aug 2021 16:31
Last modified: 29 Nov 2022 05:02

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Contributors

Author: Alexander Bull
Author: Philip H Pucher
Author: Nick Maynard
Author: Jesper Lagergren
Author: James A Gossage

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