Do you guys use NG or NJ for patients with severe pancreatitis not tolerating oral intake. Seems from uptodate you can use either. What are your thoughts?
They are small but randomized and high quality and have been replicated several times, I think thats why the AGA has remained indiscriminate towards it, ACG SAT 2019 gave a preferential, or more accurately, non inferiority NGT answer from whoever the author of the hypothetical scenario is that year.....do you place NJT endoscopically, or protocol for nurses to float in bedside?@1Cor1557
I disagree that there is extensive evidence.
The data for this is from incredibly small non-blinded studies so it would have been very hard to show a difference. The largest study showed a trend towards higher infectious complications in the NG group but didn’t reach significance (either because of sample size of 30ish patients or because there is no real difference). There was one study of NG vs TPN that showed some adverse effects of NG feeds. So...the dogma now that NG and NJ are equivalent may not be true. The issue is one of logistics. Can you get a NJ placed readily? If so, go for it but don’t delay feeds to get it done.
The recent AGA guideline says NG or NJ and that safety concerns may be present for NG feeding.
I work in a place that can get a NJ same day. It’s hard to justify taking any extra risk with these patients since I can decide to get them fed in the morning and have it start by midafternoon nearly always. If they already have a NG, I’m also fine with just using it. I hope this isn’t really a board question because there really isn’t data to support an evidence based conclusion.
That is impressive rads support/response, we get into turf wars with them regretfully about this stuff.... you are definitely right about tribal customs, for all the heck I give the cardiologists we've turned into them when it comes to EBM justifying our favorite soup du jourI’m not sure why we’ve decided it’s high quality evidence with very small samples that aren’t powered to show a difference, limited randomization and non-blinded. Definitely is the dogma. We will see if we look silly in 10 years. The data hasn’t changed and in 2018, AGA said low quality evidence and a conditional recommendation.
IR places them for us when we ask. The endoscopic NJFT is too thin to be practical.
our IR refuses to do NJ tube, they say its our responsibility. point being, there is clearly institutional variabilityThat is impressive rads support/response, we get into turf wars with them regretfully about this stuff.... you are definitely right about tribal customs, for all the heck I give the cardiologists we've turned into them when it comes to EBM justifying our favorite soup du jour