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Invited Critique
August 2012

Should Nasogastric Tubes Be Removed Early or Late?: That Is the Question: Comment on “Effect of Short-term vs Prolonged Nasogastric Decompression on Major Postesophagectomy Complications”

Author Affiliations

Author Affiliation: Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, Washington.

Arch Surg. 2012;147(8):752. doi:10.1001/archsurg.2012.1018

Opinions regarding the surgical treatment and recovery of patients undergoing esophageal resection remain as numerous as the number of surgeons involved in high-volume esophageal practices. Location and technique of the anastomosis, extent of lymph node dissection, whether to include a pyloroplasty or feeding jejunostomy, and nasogastric tube management are a few of the myriad issues for which there is no general consensus. Evidence-based assessments of these issues are few and often underpowered. Mistry and colleagues1 performed a randomized clinical trial that assessed timing of nasogastric tube removal, with the primary end points of pulmonary complications and anastomotic leak and the secondary end points of nasogastric tube reinsertion, patient discomfort scores, and mortality. Previous assessments have compared routine vs no nasogastric tube decompression. However, Mistry et al are correct when they state that most surgeons continue to use nasogastric tube decompression as a routine component of postoperative care, and as a result this well-designed assessment examining the best timing of removal is noteworthy.

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