# Nasogastric Tube Syndrome Treated by Replacement With a Smaller-Diameter Tube: A Case Report

## TL;DR

A patient with nasogastric tube syndrome improved after switching to a smaller-diameter tube instead of removing it, helping with swallowing and avoiding complications.

## Contribution

Replacing a nasogastric tube with a smaller-diameter tube is proposed as an effective treatment for nasogastric tube syndrome.

## Key findings

- Replacing a 12-Fr nasogastric tube with an 8-Fr tube improved symptoms of nasogastric tube syndrome.
- The smaller-diameter tube helped alleviate dysphagia and NGTS without removing the tube.
- This approach is feasible for patients needing continued nasogastric feeding.

## Abstract

Nasogastric tube syndrome (NGTS) is a severe and potentially life-threatening complication of the nasogastric tube. NGTS is characterized by throat pain and abductor dysfunction of vocal cords due to the presence of the NGT. NGTS sometimes progresses to acute upper airway obstruction caused by vocal cord paralysis or laryngeal infection. Early recognition and appropriate management are essential to prevent serious outcomes. Removing the nasogastric tube is generally recommended for treatment. Here, we present a case of NGTS, wherein the symptoms were improved by replacing the nasogastric tube with a smaller-diameter tube rather than removing it entirely. A 53-year-old woman suffering from left lateral medullary syndrome with a tracheostomy was admitted for dysphagia rehabilitation. She developed NGTS because of the presence of a 12-Fr nasogastric tube. Videoendoscopic evaluation of swallowing revealed right vocal cord abduction paralysis and bilateral arytenoid edema. Her oral intake was restricted because of lateral medullary syndrome and NGTS. As she was not at risk for upper airway obstruction from NGTS because of the tracheostomy, we replaced the nasogastric tube with a smaller-diameter (8-Fr) tube, resulting in an improvement in her dysphagia and NGTS. Considering that NGTS can make dysphagia worse, replacing a nasogastric tube with a smaller-diameter (8-Fr) tube may be an effective treatment for NGTS. Although this approach may extend the overall treatment duration, it offers a feasible option for patients requiring continued nasogastric tube feeding without removing the tube.