It has traditionally been taught that one of the first steps in managing an upper GI bleed is to place an NG tube to see if there are bloody aspirates. While it’s true that if you get a bloody aspirate, there is more likely to be an actively bleeding lesion, the data on whether the NG tube changes management is not too supportive.
In a Journal Watch post from 2011, David Bjorkman reviews a VA study of over 600 patients with suspected GIB. The study found that while placing an NG tube got patients faster care, it didn’t change clinical outcomes or rate of complications. He writes: “We already know that NGL cannot be used to exclude ongoing upper GI bleeding as one sixth of patients with active bleeding will have a negative NGL. Now, this study demonstrates that NGL results in no difference in a number of important clinical outcomes.”
However, if you are an ED provider, you may think differently about placing an NG tube. It may help you triage patients better in terms of who needs to be seen by GI first and whether there is evidence of a SEVERE bleed. Here is some evidence from the EM side of things.