title: Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis.
abstract: OBJECTIVE
  The utility of nasogastric aspiration and lavage in the emergency management of patients with melena or hematochezia without hematemesis is controversial. This evidence-based emergency medicine review evaluates the following question: does nasogastric aspiration and lavage in patients with melena or hematochezia and no hematemesis differentiate an upper from lower source of gastrointestinal (GI) bleeding?
  
  
  METHODS
  MEDLINE, EMBASE, the Cochrane Library, and other databases were searched. Studies were selected for inclusion in the review if the authors had performed nasogastric aspiration (with or without lavage) in all patients with hematochezia or melena and performed esophagogastroduodenal endoscopy (EGD) in all patients. Studies were excluded if they enrolled patients with history of esophageal varices or included patients with hematemesis or coffee ground emesis (unless the data for patients without hematemesis or coffee ground emesis could be separated out). The outcome was identifying upper GI hemorrhage (active bleeding or high-risk lesions potentially responsible for hemorrhage) and the rate of complications associated with the nasogastric tube insertion. Quality of the included studies was assessed using standard criteria for diagnostic accuracy studies.
  
  
  RESULTS
  Three retrospective studies met our inclusion and exclusion criteria. The prevalence of an upper GI source for patients with melena or hematochezia without hematemesis was 32% to 74%. According to the included studies, the diagnostic performance of the nasogastric aspiration and lavage for predicting upper GI bleeding is poor. The sensitivity of this test ranged from 42% to 84%, the specificity from 54% to 91%, and negative likelihood ratios from 0.62 to 0.20. Only one study reported the rate complications associated with nasogastric aspiration and lavage (1.6%).
  
  
  CONCLUSIONS
  Nasogastric aspiration, with or without lavage, has a low sensitivity and poor negative likelihood ratio, which limits its utility in ruling out an upper GI source of bleeding in patients with melena or hematochezia without hematemesis.
authors.affiliation: Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA. npdessi@hotmail.com
authors.forename: Nicholas
authors.initials: N
authors.lastname: Palamidessi
authors.forename: Richard
authors.initials: R
authors.lastname: Sinert
authors.forename: Louise
authors.initials: L
authors.lastname: Falzon
authors.forename: Shahriar
authors.initials: S
authors.lastname: Zehtabchi
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D016145:Endoscopy, Digestive System; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008551:Melena / Q000175:diagnosis / Q000628:therapy; D011237:Predictive Value of Tests; D012007:Rectum; D007507:Therapeutic Irrigation