A Propensity Score-matching Analysis Of The Necessity Of Routine Nasogastric Tube Placement After Endoscopic Full-thickness Resection Of Gastric Submucosal Tumors

Background and Purpose:Endoscopic full-thickness resection is a common endoscopic procedure for treating gastrointestinal submucosal tumors.Nasogastric tube placement is frequently performed for gastrointestinal decompression after abdominal surgery,but the routine use of this approach remains controversial.The aim of this research was to explore whether nasogastric tube placement after gastric endoscopic full-thickness resection is necessary.Methods:A retrospective study enrolled patients who underwent gastric endoscopic fullthickness resection in the First Affiliated Hospital of Nanchang University between January 2014 and January 2019,and all the patients had a tumor size ≤2 cm.1.The patients were divided into two groups according to whether a nasogastric tube was placed.Baseline characteristics and clinical outcomes were compared between the two groups.2.A 1:1 propensity score matching(PSM)method was used to compare the incidence of postoperative adverse events and hospital stay duration between the two groups.Results:1.A total of 461 patients were enrolled in this study,the mean age was 56±10 years.Gastric mesenchymal tumor was the most common pathological type,61.4%of submucosal tumors occurred in the upper third of the stomach,all patients underwent endoscopic full-thickness resection,with a 95.7%en bloc resection rate,the EFTR operative time was 33(23-46)minutes,1(0.2%)patient experienced postoperative bleeding,2(0.4%)patients experienced postoperative perforation,which were improved after endoscopic treatment.There was no mortality during hospitalisation and the average hospital stay duration for all patients was 8.1±2.1 days.2.Grouped according to whether a nasogastric tube was placed after gastric EFTR,including 385 patients in the nasogastric tube group(NGT group)and 76 patients in the non-nasogastric tube group(non-NGT group).Before matching,there was a statistically significant difference in the mode of intraoperative perforation closure in the baseline characteristics of the two groups(p<0.05).Median operation time in NGT group was significantly longer than that in non-NGT group(p=0.002),while there was no statistical difference in en bloc resection rate.5.5%of patients in the NGT group had severe nasogastric tube related throat discomfort.In addition,the NGT group was more likely to have postoperative fever(24.9%vs 9.2%,p=0.004),and the NGT group had a significantly longer hospital stay duration than that in the non-NGT group(p=0.022).3.After matching,the baseline characteristics of 73 patients in the NGT group and 73 patients in the non-NGT group were balanced(p>0.05).The postprocedural fever rate in the NGT group was still significantly higher than that in the non-NGT group(23.3%vs 9.6%,p=0.044).6.9%(5/73)of patients in the NGT group experienced severe nasogastric tube-related throat discomfort.However,the duration of hospitalization stay was not statistically significant between the two groups.Conclusions:1.Endoscopic total resection is an effective and safe treatment for submucosal tumors of the stomach.2.For patients with tumor size ≤2 cm,routine nasogastric tube placement after gastric endoscopic full-thickness resection may be unnecessary.