Nasogastric tube syndrome: A Meta-summary of case reports

Table 1 Base-line parameters of patients developing “nasogastric tube syndrome”

Case number	Author	Year of publication	Country of origin	Number of cases	Age	Sex	Comorbidities	Immunocompromised	Indication for NGT insertion
1	Sofferman and Hubbell[5]	1981	United States	4	60	Female	Cecal cancer	None	Perioperative
2	Sofferman and Hubbell[5]	1981	United States	4	74	Male	None	None	CVA
3	Sofferman and Hubbell[5]	1981	United States	4	34	Male	None	None	Severe TBI
4	Sofferman and Hubbell[5]	1981	United States	4	75	Female	Osler-Weber-Rendu disease, Anemia	None	Post-operative
5	Sofferman et al[6]	1990	United States	4	28	Male	DM, HTN, CKD	Yes (post-renal transplantation)	Perioperative period
6	Sofferman et al[6]	1990	United States	4	42	Male	DM, HTN, CKD, CAD	Yes (post-renal transplantation)	Perioperative period
7	Sofferman et al[6]	1990	United States	4	36	Male	DM, CKD	No	AMS
8	Sofferman et al[6]	1990	United States	4	45	Female	DM, CKD	Yes (post-renal transplantation)	Acute pancreatitis
9	Apostolakis et al[7]	2001	United States	2	77	Male	None	No	Toxic megacolon
10	Apostolakis et al[7]	2001	United States	2	73	Male	DM, HTN, COPD	No	GI bleed
11	To et al[8]	2001	Hong Kong	1	63	Male	NA	NA	Perioperative period
12	Nehru et al[9]	2003	Kuwait	1	60	Male	DM, HTN	No	Acute stroke
13	Sanaka et al[10]	2004	Japan	1	85	Male	HTN	No	Gastrointestinal obstruction
14	Isozaki et al[11]	2005	Japan	2	73	Male	NA	NA	Dementia
15	Isozaki et al[11]	2005	Japan	2	77	Male	NA	NA	Acute stroke
16	Marcus et al[12]	2006	Israel	1	72	Male	None	No	Traumatic brain injury
17	Vielva del Campo et al[13]	2010	Spain	1	70	Female	DM, Parkinsonism	No	Acute stroke
18	Kim et al[14]	2015	Korea	1	86	Female	DM, HTN, Parkinsonism	NA	Severe pneumonia with septic shock
19	Sano et al[15]	2016	Japan	1	76	Male	No	No	GI obstruction
20	Perera[16]	2018	Sri Lanka	1	76	Female	NA	NA	Acute stroke
21	Kanbayashi et al[17]	2021	Japan	1	77	Male	HTN, AF	No	Acute stroke
22	Yildiz et al[18]	2021	Türkiye	1	73	Male	NA	NA	Perioperative
23	Taira et al[19]	2022	Japan	1	78	Male	No	NA	AMS
24	Cui et al[20]	2023	China	1	65	Female	HTN, Parkinsonism	No	Cervical cord injury
25	Nihira et al[21]	2023	Japan	1	86	Female	None	No	Acute stroke
26	Paul et al[22]	2023	Qatar	2	78	Female	DM, HTN	No	Perioperative
27	Paul et al[22]	2023	Qatar	2	79	Female	DM, CAD	No	AMS

NGT: Nasogastric syndrome; DM: Diabetes mellitus; HTN: Hypertension; CKD: Chronic kidney disease; CAD: Coronary artery disease; AMS: Altered mental status; NA: Not available; COPD: Chronic obstructive pulmonary diseases; CVA: Cerebrovascular accident; TBI: Traumatic brain injury; GI: Gastrointestinal; AF: Atrial fibrillation.

Table 2 Clinical course of patients with nasogastric syndrome

Case number	Presenting symptoms	Type of feed NGT	Days after which symptoms developed	Side of vocal cords involved	Laryngoscopy	Biopsy	Culture	Therapeutic interventions	Tracheostomy	Outcome	Sequalae
1	Voice change, throat pain	NG	3	B/L	Vocal cord edema, post cricoid abcess	None	None	NG removal, steroids, antibiotics	Yes	Alive	Recovered in 7 d and discharged
2	Sore throat, stridor	NG	8	B/L	Vocal cod edema, arytenoid edema, post cricoid ulceration	None	None	NG removal	Yes	Alive	Recovery in 14 d
3	Throat discomfort, aspiration,	NG	30	B/L	Vocal cord edema and paralysis, postcricoid edema	1	None	NG removal, gastrostomy placement	Yes	Alive	Gastrostomy support required even after 12 wk follow up
4	Stridor, troat pain	NG	9	B/L	Vocal cord paralyis and arytenoid edema	None	None	Removal of tube	Yes	Alive	Recovered completely 15 d after tube removal
5	Stridor, throat pain	NG	18	B/L	Vocal cord edema and post cricoid ulcer	NA	Coagulase positive staph aureus	NGT removal	Yes	Alive	One month after trach – VC mobile, but residual arytenoid edema
6	Throat pain, fever	NG	5		Vocal cord edema and post cricoid ulcer	NA	Streptococcus	NGT removal	No	Alive
7	Stridor	NA	16		Vocal cord edema and post cricoid ulcer	NA	None		Yes	Died
8	Stridor, fever	NG	NA	B/L	B/L vocal cord edema	NA	Candida albicans	NGT removal	Yes	Alive	54 d after – both VC recovered sufficient abductor mobility and decannulation done
9	Stridor	NG	2	B/L	Impaired vocal cord abduction bilaterally. With edema. Postcricoid necrotic ulcer was noted, 1.5 cm in width	No	Mixed bacterial growth	NGT removal	Yes	Alive	No recovery till 1 month
10	SOB	NG	2	B/L	Isolated and complete abductor dysfunction of his vocal cords. With edema. Postcricoid ulceration	No	Mixed bacterial growth	NGT removal, steroids	Yes	Alive	Decannulated after 5 wk
11	Cough, sore throat	NG	9	Left VC paralysis	Left arytenoid fold swollen	No	None	NGT removal	No	Alive	None
12	Incidental	NG	140	Lt	Left- inhibited abductor movement	Yes	None	NG removal	Yes	Alive	Persistent VC palsy
13	Stridor, SOB	Long intestinal tube	4	B/L	Mild arytenoid edema	No	None	Removal of tube	Yes	Alive	Decannulated after 3 wk
14	Stridor	NG	730	B/L	B/L VC edema	No	None	NA	No	Died
15	Stridor	NG	75	B/L	B/L VC edema	No	None	Frequent NG changes	No	Died
16	Stridor, tachypnea, SOB	NG	30	B/L	Right VC paralysis, impaired left VC mobility, B/L edema	No	None	NGT removal, steroids	No	Alive	None
17	Stridor, SOB	NG	35	B/L	Bilateral arytenoid edema	No	None	NGT removal	Yes	Yes	Decannualted after 20 d
18	Stridor, desaturation, AMS	NG	15	B/L	Impaired abduction of the Vocal cords	No	None	NGT removal, steroids	No	Alive	None
19	Stridor, throat pain, desaturation	Long intestinal tube	6	B/L	B/L arytenoid edema	No	None	NGT removal	Yes	Alive	Decannulated after 4 wk
20	Stridor, throat pain, Respiratory distress	NG	14	B/L	Bilateral vocal cord palsy with severely compromised airway.	No	None	NGT removal, steroids	Yes	Alive	Improved after 4 wk
21	Stridor	NG	14	B/L	B/L VC palsy	No	None	NGT removal	No	Alive	None
22	Stridor, slurring of speech, sore throat, difficulty in swallowing, desaturation	NG	7	B/L	B/L vocal cord edema	No	None	NGT removal, steroids	Yes	Alive	A month to complete recovery
23	Wheezing, hoarseness	Nasointestinal ileus tube	3	B/L	Left arytenoid edema and erythema	No	None	Tube removal, steroids	No	Alive	None
24	Incidental	NG	15	B/L	Severe edema	No	None	Inhaled steroids	Yes	Alive	Decannulated after 5 wk
25	Stridor	NG	105	B/L	BL laryngeal edema	No	None	NGT removal	Yes	Alive	None
26	Desaturation	NG	180	Rt	Rt VC palsy	No	None	Neb steroids	NA	Alive	None
27	Stridor	NG	760	Rt	Rt VC palsy	No	None	Neb steroids	NA	Alive	None

¹Proliferative interarytenoid granulation tissue and no abscess.

NG: Nasogastric; B/L: Bilateral; NA: Not available; SOB: Shortness of breath; VC: Vocal cords; NGT: Nasogastric tube.

Table 3 Clinical course of patients with nasogastric syndrome

Indication for NGT	Number of patients, n (%)
Acute stroke	10 (37.04)
Peri-operative period	7 (25.93)
Altered mental status	4 (14.81)
Gastrointestinal obstruction	2 (7.41)
Traumatic brain or spinal cord injury	2 (7.41)
GI bleed	1 (3.7)
Acute pancreatitis	1 (3.7)
Severe pneumonia with septic shock	1 (3.7)
Toxic megacolon	1 (3.7)
Presenting symptoms
Stridor	17 (62.96)
Sore throat/throat pain	7 (25.93)
Shortness of breath	4 (14.8)
Desaturation	3 (11.11)
Speech disturbance	4 (14.8)
Swallowing difficulty	3 (11.11)
Cough	1 (3.7)
Altered sensorium	1 (3.7)
Incidental	2 (7.41)
Type of feed NGT
Nasogastric	23 (85.19)
Long intestinal tube	1 (3.7)
Naso-intestinal ileus tube	2 (7.41)
NA	1 (3.7)
Vocal cord involved
Bilateral	21 (77.78)
Left	2 (7.41)
Right	2 (7.41)
Therapeutic interventions
Tube removal	21 (77.78)
Systemic steroids	7 (25.93)
Inhalational steroids	4 (14.81)
Frequent change of nasogastric tube	1 (3.7)
Tracheostomy procedure
Yes	17 (62.96)
No	8 (29.63)
NA	2 (7.41)
Final outcome
Alive	23 (85.19)
Dead	3 (11.11)
NA	1 (3.7)
Reported sequelae of NGT syndrome
Improved after 3 wk	4 (14.81)
Improved after 4 wk	2 (7.41)
Partial improvement after 4 wk	1 (3.7)
Improved after 5 wk	2 (7.41)
Improved after 8 wk	2 (7.41)
No recovery till 4 wk	1 (3.7)
Persistent vocal cord palsy	2 (7.41)
None reported	8 (29.63)

NG: Nasogastric; NGT: Nasogastric tube; NA: Not available; GI: Gastrointestinal.