Nasogastric Tube Syndrome: The Size and Type of the Nasogastric Tube May Contribute to the Development of Nasogastric Tube Syndrome

Abstract

Nasogastric tube syndrome (NGTS) is a rare but life-threatening complication associated with nasogastric tube (NGT) placement. The effect of the NGT size and type on the development of NGTS has not yet been fully elucidated. We herein report the case of a 77-year-old man with cerebral infarction who was complicated with NGTS. The immediate removal of the NGT improved the symptoms of NGTS. Although the NGT was passed through the same route during reinsertion, the use of a softer and smaller-sized NGT did not cause any NGTS recurrence. To prevent the development of NGTS, using a NGT that is appropriate for the patient's condition is important.

Bilateral vocal cord palsy induced by long‐term use of small‐bore nasogastric tube

“…As the posterior cricoarytenoid muscle is a thin tissue that exists behind the cricoid cartilage, even with a small tube diameter, the repeated rubbing force of the tube over a long period of time, and the pressure exerted by the cricoid cartilage, vertebral body, and nasogastric tube in the supine position could have disrupted the perfusion of the posterior cricoarytenoid muscle, and induced muscle ischemia, as proposed by Isozaki et al 2 Our case is unique in that it developed after long-term implantation, despite using the smallest-bore soft tube in an adult patient. 1,3,5 These facts indicate that NGTS is an unavoidable complication of nasogastric tube insertion. This case suggests that NGTS might not be avoidable, even with small-diameter tubes.…”

“…The fourth mechanism proposed by Isozaki et al concerning cases without ulcer formation is that posterior cricoarytenoid muscle ischemia results from compression 2 . Considering these hypotheses, it has been speculated that tube diameter influences the pathogenesis of NGTS 3 . The nasogastric tube sizes reported previously were 16–18F, and it is not clear how large a tube should be to induce NGTS.…”

“…The nasogastric tube sizes reported previously were 16–18F, and it is not clear how large a tube should be to induce NGTS. In addition to the size, the material of the nasogastric tube is suspected to affect NGTS because of plasticizer elution, which alters tube flexibility 3 . Therefore, it is possible that the onset of NGTS cannot be avoided even with a small diameter of 8F.…”

Unilateral Variant of NGT Syndrome: An Uncommon Complication of a Very Common Intervention

“…The use of an appropriate size and type of NGT according to the patient’s condition is very important to prevent the development of NGT Syndrome. The western guidelines for enteral nutrition recommend using a soft, flexible, small size nasogastric tube (12 French or less) for long-term enteral feeding (Kanbayashi et al, 2021). In both our cases nasogastric tube syndrome developed despite the use of a smaller-sized feeding tubes, the nasogastric tube size was 12 Fr.…”

“…Hence, the type of Nasogastric tube might also be a factor in development of nasogastric tube Syndrome. A soft flexible one is preferred to the rigid tube (Kanbayashi et al, 2021).…”