Abstract Background: Nasogastric tube insertion and confirmation of its position can be difficult in the anesthetized patient. The purpose of the present study was to compare the bubble technique with the conventional method for confirmation of nasogastric tube placement in these patients. Methods: Two hundred sixty adult patients, aged between 20–70 years, posted for surgeries requiring general anesthesia, tracheal intubation, and a nasogastric tube were enrolled in this study. Patients were randomized into 2 groups: Group B (Bubble group) and Group C (Control group). In Group C, a conventional technique using a lubricated nasogastric tube was positioned through the nostril with head remained neutral. In Group B, 2% lidocaine jelly was added to the proximal end to form a single bubble. The correct placement of the nasogastric tube in the stomach was confirmed by fluoroscopy by an independent observer intraoperatively. Results: The duration of nasogastric tube insertion was 57.2 ± 13.3seconds in Group B and 59.8 ± 11.9seconds in Group C (p = 0.111). The confirmation rate of the bubble technique was 76.8% (95% CI: 68.7–83.3), which was significantly better than the conventional method where the confirmation rate was 59.7% (95% CI 50.9-67.9), p< 0.001. When compared to fluoroscopy, bubble technique was found to have a sensitivity of 92.3% (95% CI: 85.6–96.1) with specificity of 81.0% (95% CI: 60.0–92.3), positive predictive value of 96.0% (95% CI: 90.2–98.4), and a moderate negative predictive value of 68.0% (95% CI: 48.4–82.8). Conclusions: The bubble technique of nasogastric tube insertion has a higher confirmation rate in comparison to the conventional technique. Trial Registry Number: Clinical Trial Registry of India (CTRI/2018/09/015864).

ABSTRACT Background: The term inflammatory bowel disease-unclassified (IBDU) is used when an individual has chronic colitis but cannot be sub-typed into ulcerative colitis (UC) or Crohn’s disease (CD) on the basis of the clinical, endoscopic, imaging and histopathological features. On follow-up a proportion of patients with IBDU are re-classified as CD or UC. There has been considerable variability in the frequency and reclassification rates of pediatric IBDU in published literature. Methods: PubMed and Scopus and were searched for publications related to Pediatric Inflammatory Bowel Disease (PIBD) published between Jan,2014 and July,2021. Two reviewers independently searched and selected studies reporting the frequency of IBDU and/or their re-classification. The pooled prevalence was expressed as proportion and 95%CI. Meta-analysis was performed using the inverse variance heterogeneity model. Results: A total of 2750 studies were identified through a systematic search of which 27 studies were included in this systematic review. The overall pooled frequency of IBDU (n=16064) was found to be 7.1% (95%CI 5.8-8.5%). There was no variation in IBDU frequency by geographical location. Seven studies (n=5880) were included in the IBDU re-classification analysis. Overall, 50% (95%CI 41-60%) children with IBDU were re-classified on follow-up. Amongst these 32.7% (95% 21-44%) were re-classified to UC and 17% (95%CI 12-22%) were re-classified to CD. Conclusion: IBDU comprises 7.1% of PIBD at initial diagnosis. Half of these children are re-classified into UC or CD on follow-up with a higher likelihood of re-classification to UC as compared to CD.

RESUMO Contexto: O termo doença inflamatória intestinal não classificada (DIINC) é usado quando um indivíduo tem colite crônica, mas não pode ser sub tipificado em colite ulcerativa (UC) ou doença de Crohn (DC) com base nas características clínicas, endoscópicas, de imagem e histopatológicas. No acompanhamento, uma proporção de pacientes com DIINC são reclassificadas como DC ou UC. Houve considerável variabilidade nas taxas de frequência e reclassificação de DIINC pediátrico na literatura publicada. Métodos: Foram procuradas publicações no PubMed e Scopus relacionadas à doença inflamatória pediátrica intestinal publicadas entre janeiro de 2014 e julho de 2021. Dois revisores pesquisaram e selecionaram estudos independentemente relatando a frequência da DIINC e/ou sua reclassificação. A prevalência agrupada foi expressa em proporção e para IC95%. A meta-análise foi realizada utilizando o modelo de heterogeneidade de variância inversa. Resultados: Foram identificados 2.750 estudos por meio de uma busca sistemática, dos quais 27 estudos foram incluídos nesta revisão sistemática. A frequência total agrupada da DIINC (n=16064) foi de 7,1% (IC95% 5,8-8,5%). Não houve variação na frequência da DIINC por localização geográfica. Sete estudos (n=5880) foram incluídos na análise de reclassificação da DIINC. No geral, 50% (IC95% 41-60%) foram reclassificadas no seguimento. Entre esses 32,7% (95% 21-44%) foram reclassificados para UC e 17% (IC95%12-22%) foram reclassificados para DC. Conclusão: DIINC compreende 7,1% da doença inflamatória pediátrica intestinal no diagnóstico inicial. Metade dessas crianças são reclassificados em UC ou DC no seguimento com maior probabilidade de reclassificação para UC em comparação com o DC.