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©The Author(s) 2024.
World J Clin Cases. Jan 6, 2024; 12(1): 119-129
Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.119
Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.119
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 |
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 |
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) |
- Citation: Juneja D, Nasa P, Chanchalani G, Jain R. Nasogastric tube syndrome: A Meta-summary of case reports. World J Clin Cases 2024; 12(1): 119-129
- URL: https://www.wjgnet.com/2307-8960/full/v12/i1/119.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v12.i1.119