Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding

Background: Active upper-GI bleeding (spurting or oozing) or a visible vessel at endoscopy are high-risk lesions that predict recurrence of bleeding. The aim of this study is to determine whether nasogastric aspirate predicts the presence of high-risk lesions. Methods: The Canadian Registry of patients with Upper Gastrointestinal Bleeding undergoing Endoscopy was used to identify patients with upper-GI bleeding who underwent nasogastric aspiration and subsequent endoscopy. An association between nasogastric aspirate findings (bloody, "coffee ground," clear/bile) and high-risk lesions was sought. Results: Of 1869 patients in the registry, 520 had documented nasogastric aspiration before endoscopy. Those who underwent aspiration did not differ from those who did not. A bloody nasogastric aspirate was significantly associated with high-risk lesions (odds ratio 4.82: 95% CI[2.3, 10.1] vs. clear/bile; and odds ratio 2.8: 95% CI[1.8, 4.3] vs. coffee ground). A bloody nasogastric aspirate had the highest specificity for high-risk lesions (75.8%: 95% CI[70.0, 80.0]) with a negative predictive value of 77.9%: 95% CI[73.2, 82.0], and raised the probability of having a high-risk lesions from 0.29 to 0.45. A clear nasogastric aspirate reduced the likelihood to 0.15. Nasogastric aspirate yielded the most useful information in hemodynamically stable patients without hematemesis. Conclusions: Nasogastric aspirate is useful in predicting high-risk lesions. Whether it can be used to determine which patients would benefit from earlier endoscopy deserves further study.