{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T19:15:06Z","timestamp":1773688506714,"version":"3.50.1"},"reference-count":16,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,6]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Nasogastric tubes (NGTs) are standard practice in the management of adhesive small bowel obstruction (ASBO). Their insertion can be associated with significant patient discomfort and complications. Current research suggests that patients with ASBO managed with NGTs may experience poorer outcomes and higher rates of operative intervention compared with those managed without. However, to date, there are no prospective clinical trials evaluating this.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This study will be designed as a single centre, prospective, non-inferiority randomised controlled trial to determine if the avoidance of an NGT is non-inferior to its use in ASBO. Patients meeting inclusion criteria will be randomised to either receive an NGT or no NGT for ASBO management. The primary outcome will be the rate of operative intervention as determined by review of medical records at day 30 post discharge. Secondary outcomes will include rate of bowel resection or bowel ischaemia, length of hospital and intensive care unit (ICU) stay, time to operative intervention, rate of ICU admission, incidence of postoperative complications (Clavien-Dindo classification), quality of life scores (European Quality of Life 5 Dimension 5 Level: EQ-5D-5L) at admission, day 30 and day 90, 90-day mortality, incidence of pulmonary complications (Melbourne Group Scale), rate of NGT specific complications and rate of Gastrografin use. The study will be powered at 80% to detect a clinically relevant difference of 10% between groups receiving an NGT compared with no NGT, requiring a total of 490 study participants. Statistical analysis will follow intention to treat principles. Differences between treatment arms will be summarised using mean differences, 95% CIs and p values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has been approved by the Hunter New England Human Research Ethics Committee (2023\/ETH00296). Results will be disseminated through peer-reviewed publication and conference presentations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>This study has been registered prospectively in the Australia and New Zealand Clinical Trials Registry (ACTRN12623000341628).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-097986","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T10:50:24Z","timestamp":1766055024000},"page":"e097986","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Prospective randomised controlled trial of the use of nasogastric tubes in patients with adhesive small bowel obstruction (ASBO): protocol for the NASBO study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5271-5913","authenticated-orcid":false,"given":"Ali","family":"Al-Mashat","sequence":"first","affiliation":[{"name":"Department of General Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia"},{"name":"The University of Newcastle School of Medicine and Public Health, Callaghan, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen Ridley","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of General Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia"},{"name":"The University of Newcastle School of Medicine and Public Health, Callaghan, New South Wales, Australia"},{"name":"Hunter Surgical Clinical Research Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Gani","sequence":"additional","affiliation":[{"name":"The University of Newcastle School of Medicine and Public Health, Callaghan, New South Wales, Australia"},{"name":"Hunter Surgical Clinical Research Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine J","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"Department of General Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia"},{"name":"The University of Newcastle School of Medicine and Public Health, Callaghan, New South Wales, Australia"},{"name":"Hunter Surgical Clinical Research Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Burnett","sequence":"additional","affiliation":[{"name":"Department of General Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia"},{"name":"The University of Newcastle School of Medicine and Public Health, Callaghan, New South Wales, Australia"},{"name":"Hunter Surgical Clinical Research Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosemary","family":"Carroll","sequence":"additional","affiliation":[{"name":"Hunter Surgical Clinical Research Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5905-6357","authenticated-orcid":false,"given":"Natalie","family":"Lott","sequence":"additional","affiliation":[{"name":"Hunter Surgical Clinical Research Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"2026010703473879000_15.12.e097986.1","doi-asserted-by":"crossref","unstructured":"Rami Reddy SR , Cappell MS . A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep 2017;19. doi:10.1007\/s11894-017-0566-9","DOI":"10.1007\/s11894-017-0566-9"},{"key":"2026010703473879000_15.12.e097986.2","first-page":"60","article-title":"Intestinal obstruction from adhesions--how big is the problem","volume":"72","author":"Menzies","year":"1990","journal-title":"PubMed"},{"key":"2026010703473879000_15.12.e097986.3","doi-asserted-by":"crossref","unstructured":"Ghimire P , Maharjan S . n.d. Adhesive Small Bowel Obstruction: A Review. J Nepal Med Assoc 61:390\u20136. doi:10.31729\/jnma.8134","DOI":"10.31729\/jnma.8134"},{"key":"2026010703473879000_15.12.e097986.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13017-018-0185-2","article-title":"Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group","volume":"13","author":"Ten Broek","year":"2018","journal-title":"World J Emerg Surg"},{"key":"2026010703473879000_15.12.e097986.5","doi-asserted-by":"crossref","first-page":"2693","DOI":"10.1177\/00031348221126952","article-title":"Financial and Inpatient Burden of Adhesion-Related Small Bowel Obstruction: A Systematic Review of the Literature","volume":"89","author":"Garoufalia","year":"2023","journal-title":"Am Surg"},{"key":"2026010703473879000_15.12.e097986.6","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.jamcollsurg.2019.12.006","article-title":"Impact of Operative Management on Recurrence of Adhesive Small Bowel Obstruction: A Longitudinal Analysis of a Statewide Database","volume":"230","author":"Medvecz","year":"2020","journal-title":"J Am Coll Surg"},{"key":"2026010703473879000_15.12.e097986.7","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31827891a1"},{"key":"2026010703473879000_15.12.e097986.8","doi-asserted-by":"crossref","DOI":"10.1590\/1518-8345.3355.3400","article-title":"Nasogastric\/nasoenteric tube-related adverse events: an integrative review","volume":"29","author":"Motta","year":"2021","journal-title":"Rev Lat Am Enfermagem"},{"key":"2026010703473879000_15.12.e097986.9","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1016\/j.ajem.2017.08.029","article-title":"Nasogastric decompression not associated with a reduction in surgery or bowel ischemia for acute small bowel obstruction","volume":"35","author":"Berman","year":"2017","journal-title":"Am J Emerg Med"},{"key":"2026010703473879000_15.12.e097986.10","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1177\/000313481307900433","article-title":"Routine nasogastric decompression in small bowel obstruction: is it really necessary?","volume":"79","author":"Fonseca","year":"2013","journal-title":"Am Surg"},{"key":"2026010703473879000_15.12.e097986.11","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/j.amjsurg.2021.11.029","article-title":"Nonoperative management without nasogastric tube decompression for adhesive small bowel obstruction","volume":"223","author":"Shinohara","year":"2022","journal-title":"Am J Surg"},{"key":"2026010703473879000_15.12.e097986.12","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1933.02740450006002"},{"key":"2026010703473879000_15.12.e097986.13","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1503\/cjs.010814","article-title":"Amnesia in modern surgery: revisiting Wangensteen\u2019s landmark studies of small bowel obstruction","volume":"58","author":"Faryniuk","year":"2015","journal-title":"cjs"},{"key":"2026010703473879000_15.12.e097986.14","unstructured":"Sealed envelope . Randomisation (randomization) and online databases for clinical trials. Available: https:\/\/www.sealedenvelope.com\/"},{"key":"2026010703473879000_15.12.e097986.15","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jphys.2024.07.001","article-title":"Clinimetrics: The Melbourne Group Scale","volume":"70","author":"Boden","year":"2024","journal-title":"J Physiother"},{"key":"2026010703473879000_15.12.e097986.16","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8510(90)90421-9"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-097986","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:50:01Z","timestamp":1767786601000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-097986"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":16,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,18]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bmjopen-2024-097986"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-097986","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}