The Role of Routine Placement of Nasogastric Tube in Patients with Suspected Upper Gastrointestinal Tract Hemorrhage

Study ID
STU 062010-142

Cancer Related
No

Healthy Volunteers
No

Study Sites

Contact
Rebecca Chason
214-590-6607
rebecca.chason@utsouthwestern.edu

Principal Investigator
Deepak Agrawal

Summary

our study would like to enroll consecutive participants with uGiB and compare the results of the nGa with the endoscopic results. We are also using a questionnaire where the treating physician will give a number for his/her clinical impression for a high risk endoscopic lesion before and after the nGa as well as what is the culprit lesion based on his/her clinical assessment. The researchers will interview the treating physician and fill the questionnaire according to their clinical impression.The blood collection is part of the standard of care in participants with uGiH. it is collected for routine blood work considered standard of care for participants with upper Gi Bleed, including complete blood count with differential, comprehensive metabolic panel, prothrombin time, inR, PTT. This usually involves about 10 to 15 ml of blood collection. our protocol is going to use the blood work results available on each participants based on a retrospective review of the patient's charts. We are going to assess the medical record for hemoglobin, hematocrit, white blood cell count, platelet count, prothrombin time, inR, Bun, Creatinine, Bun/Creatinine ratio. no additional blood (other than that collected as part of standard care) will be collected for the purposes of this study. Both, the nGa and the eGD are considered standard of care in participants with uGiH. There will be no harm to the participants on forgoing the nGa because all will have an eGD, therefore having the ultimate tool for diagnosis and treatment. Participants will be randomized to nGa versus no nGa. The nGa will be performed by the treating physician, not the investigator, and its results will be recorded in the case report form. The nGa must be randomized to evenly distribute the benefits and risk of the nGa. otherwise, the treating physician will preferentially use the nGa on participant without coagulopahy and thrombocytopenia and withhold it in cirrhotic participants. Subsequently, we will evaluate if the nGa is helpful in identifying endoscopically significant lesions by comparing the result of the nGa with the results of the eGD.
a flow chart of the study is:
1.The patient will be evaluated by the eR physician
2.The eR physician will then contact investigator
3.The eR physician will continue to treat the participant as standard of care (vital signs will be collected, blood test, blood, transfusion if indicated)
4.The investigator will come to the emergency room and consent the participant
5.if participant is agreeable, he/she will be randomized to nGa or no nGa (to be performed by the eR physician)
6.The questionnaire will then be filled by the eR physician or the investigator
7.Gi service will be consulted as they are for every Gi bleed participant
8.Most patients will then undergo as eGD
9.Results of the eGD will be obtained by the investigator through review of the participant's medical record
10.all laboratory data for the case report form will obtained through review of the participant's medical record
Participanton the ward or Cu who develops an uGiH:
11.The participant will be evaluated by the treating physician
12.The treating physician will then contact investigator
13.The treating physician will continue to treat the participant as standard of care (vital signs will be collected, blood test, blood, transfusion if indicated)
14.The investigator will come to participant's room and consent the participant.
15.if patient is agreeable, he/she will be randomized to nGa or no nGa (to be performed by the treating physician)
16.The questionnaire will then be filled by the eR physician or the investigator
17.Gi service will be consulted as they are for every Gi bleed participant
18.Most participants will then undergo as eGD
19.Results of the eGD will be obtained by the investigator through review of the participant's medical record

Participant Eligibility

We will include all patients older than 21 years-old presenting to Parkland Memorial Hospital with UGIH, defined as the presence of a bleeding lesion proximal to the ligament of Treitz.

Clinically, we will define as a patient who presents with the following complaints:
-melena,either witnessed or reported
-hematemesis, including coffee grounds emesis, either witnessed or reported
-hematochezia, if presence of bloody NGA
-blody nasogastric aspirate