Modified gastric biopsy forceps as a flexible stylet-assisted nasogastric tube insertion in anesthetized and intubated patients: A prospective randomized controlled study

Background: Insertion of a nasogastric tube in an anesthetized intubated patient may be difficult. A nasogastric tube is prone to coil and kink during insertion. The authors hypothesized that gastric biopsy forceps could be used as a flexible stylet-assisted nasogastric tube insertion. It can improve the first-attempt success rate over the conventional blind technique during nasogastric tube insertion in the anesthetized intubated patient. Materials and Methods: Eighty adult patients who required intraoperative nasogastric tube insertions were randomized to the gastric biopsy forceps assisted technique (stylet group) or the conventional blind technique (control group) for insertion of a nasogastric tube. The success rates, the duration of insertion, the incidences of coiling and kinking of a nasogastric tube, and the occurrences of complications were recorded. Results: The first-attempt success rate was 92.5% in the stylet group compared with 65% in the control group (p=0.013). The overall success rate was higher in the stylet group (100% versus 85%, p=0.026). The mean time required to insert the nasogastric tube was shorter in the stylet group (24.85±9.62 versus 62.4±59.38 seconds, p=0.002). The incidences of coiling and kinking were lower in the stylet group (7.5% versus 32.5%, p=0.005). The incidence of minor bleeding was lower in the stylet group, but not statistically significant (2.5% versus 17.5%, p=0.057). No other complications were observed in either groups. Conclusion: The gastric biopsy forceps-assisted nasogastric tube insertion resulted in a higher success rate, less time for insertion, and lower incidence of coiling and kinking of a nasogastric tube than the conventional blind technique in anesthetized intubated patients without serious complications.