Safety and Efficacy of Nasogastric Tube Placement Prior to Long Tube Placement for the Conservative Management of Adhesive Small Bowel Obstruction: A Retrospective Analysis.

Objective: Adhesive small bowel obstruction (ASBO) without strangulation or ischemia is typically treated conservatively. Compared to nasogastric tube (NGT) placement, long tube (LT) placement has shown lower surgery rates, but it is more invasive and may be poorly tolerated in frail patients. This study evaluated the safety and efficacy of initial NGT placement followed by LT placement in ASBO. Methods: We retrospectively analyzed 337 ASBO-related admissions between 2019 and 2023. Analyses were performed on an admission-level basis. After exclusions, admissions were categorized into the NGT group (initial NGT placement, n=135), and the LT group (initial LT placement, n=60). Admissions requiring LT placement after NGT placement were defined as the NGT+LT group (n=63). Clinical characteristics, treatment outcomes, and adverse events were compared between groups. Results: Admissions in the NGT group involved older patients and a poorer performance status than the LT group; similar differences were observed between the NGT+LT and LT groups. LT placement time was significantly shorter in the NGT+LT group compared with the LT group (18 vs. 24 minutes, p < 0.001). No statistically significant differences were observed between the NGT+LT and LT groups in surgery rates (13% vs. 12%), hospital stay, mortality, or adverse events. In admissions treated with NGT alone, the surgery rate was 4%, and clinical outcomes were favorable. Conclusions: Initial NGT placement followed by selective LT insertion appears to be a reasonable stepwise treatment strategy in real-world clinical practice, associated with a lower proportion of admissions requiring LT placement and shorter LT insertion time.