Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.119
Peer-review started: October 28, 2023
First decision: December 5, 2023
Revised: December 7, 2023
Accepted: December 18, 2023
Article in press: December 18, 2023
Published online: January 6, 2024
Processing time: 66 Days and 3.7 Hours
Since its description in 1790 by Hunter, the nasogastric tube (NGT) is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding. However, the risks associated with its placement are often underestimated. Upper airway obstruction with a NGT is an uncommon but potentially life-threatening complication. NGT syndrome is characterized by the presence of an NGT, throat pain and vocal cord (VC) paralysis, usually bilateral. It is poten
To review and collate the data from the published case reports and case series to understand the possible risk factors, early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway obstruction.
We conducted a systematic search for this meta-summary from the database of PubMed, EMBASE, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Google scholar, from all the past studies till August 2023. The search terms included major MESH terms "Nasogastric tube", "Intubation, Gastrointestinal", "Vocal Cord Paralysis", and “Syndrome”. All the case reports and case series were evaluated, and the data were extracted for patient demographics, clinical symptomatology, diagnostic and therapeutic interventions, clinical course and outcomes. A datasheet for evaluation was further prepared.
Twenty-seven cases, from five case series and 13 case reports, of NGT syndrome were retrieved from our search. There was male predominance (17, 62.96%), and age at presentation ranged from 28 to 86 years. Ten patients had diabetes mellitus (37.04%), and nine were hypertensive (33.33%). Only three (11.11%) patients were reported to be immunocompromised. The median time for developing symptoms after NGT insertion was 14.5 d (interquartile range 6.25-33.75 d). The most commonly reported reason for NGT insertion was acute stroke (10, 37.01%) and the most commonly reported symptoms were stridor or wheezing 17 (62.96%). In 77.78% of cases, bilateral VC were affected. The only treatment instituted in most patients (77.78%) was removing the NG tube. Most patients (62.96%) required tracheostomy for airway protection. But 8 of the 23 survivors recovered within five weeks and could be decannulated. Three patients were reported to have died.
NGT syndrome is an uncommon clinical complication of a very common clinical procedure. However, an under-reporting is possible because of misdiagnosis or lack of awareness among clinicians. Patients in early stages and with mild symptoms may be missed. Further, high variability in the presentation timing after NGT insertion makes diagnosis challenging. Early diagnosis and prompt removal of NGT may suffice in most patients, but a significant proportion of patients presenting with respiratory compromise may require tracheostomy for airway protection.
Core Tip: Nasogastric tube (NGT) insertion is a commonly employed procedure in hospitalised patients. Although it is considered a minor and safe procedure, complications may occur due to its invasive nature. Immediate complications while NGT insertion may be easily recognised, but long-term complications may be missed and are rarely reported. Most of the complications are minor and can be rapidly detected, but rarely, life-threatening complications like NGT syndrome have also been reported. NGT syndrome has been described decades ago, but till now, very few adult cases have been reported in the literature. Timely recognition and a simple intervention of NGT removal may be life-saving, and most patients may show complete recovery. However, a significant proportion of these patients may require tracheostomy for airway protection until the vocal cord palsy recovers.