Evolving Therapeutic Roles of Nasogastric Tubes: Current Concepts in Clinical Practice

Nalini Vadivelu 1, Gopal Kodumudi 2, Lisa R Leffert 1, Doris C Pierson 1, Laura K Rein 1, Matthew S
Silverman 1, Elyse M Cornett 2, Alan D Kaye 2,3,✉

 Author information

 Article notes

 Copyright and License information

PMCID: PMC9838367 PMID: 36637690

Abstract

Nasogastric tubes (NGT) have been in use for over 100 years and are still considered as essential and
resuscitative tools in multiple medical specialties for acute and chronic care. They are vital for
decompression of the stomach in the presence of bowel obstruction in the critically ill and useful as a
conduit for the administration of medications and sometimes for short term parenteral nutrition. The
placement of nasogastric tubes is relatively routine. However, they must be inserted and maintained
safely and effectively to avoid serious and possibly even fatal associated complications. This review
focuses on recent updates in research regarding nasogastric tubes. Cognizance of the recent advances in
indications, contraindications, techniques of insertion, confirmation of correct positioning, securement,
complications, management of complications, and state of the art research about the nasogastric tube is
crucial for practitioners of all medical and surgical specialties.

Keywords: Nasogastric tubes, Bowel obstruction, Nasopharynx, Oropharynx, Palliative care, Chronic care

Key Summary Points

Although nasogastric tube (NGT) installation is quite common, it must be done correctly and securely to minimize
difficulties

The location and tip of the NGT must be validated by radiography after blind installation

Recent improvements suggest that point-of-care ultrasound (POCUS) might be utilized for NGT insertion in the acute care
scenario when expertise is available at the bedside

This has been shown to be especially beneficial in intensive care unit (ICU) settings for patients with COVID-19. Patients
who have adequate intestinal absorption capacity but are unable to eat orally can seek endoscopic enteral feeding access

Current NGTs on the market often pose difficulties in maintaining stomach decompression during postpyloric enteral
feeding or as a postoperative nasogastric enteral feeding tube

The development and testing of dual-purpose nasogastric and nasojejunal tubes to enhance nutrition treatment and
patient safety are now underway

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Society of Gastrointestinal
Endoscopy (ESGE) provide valuable suggestions for more smoothly structuring and standardizing enteral nutrition

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Introduction

Nasogastric tubes (NGTs) are widely used in multiple specialties including surgery (perioperatively),
gastroenterology, pediatrics, and palliative care, in both acute and chronic care settings. More than a
million NGTs are placed every year in the USA [1]. NGTs have been used for over 100 years and were first
described in 1921 by Dr. Abraham Levin. NGTs are tubes inserted through the nose past the
nasopharynx, oropharynx, and esophagus to reach the stomach. The main purposes of NGTs include
decompression of the stomach in the presence of ileus or intestinal obstruction and the administration
of medication or nutrition by enteral feeding to patients unable to tolerate oral intake, such as patients
with dysphagia or critical illness [1]. Small bowel obstruction from hernias, ileus, adhesions (band
obstruction), neoplasms obstructing lumen, volvulus, intussusception, and other causes can hinder the
normal passage of several secretions such as that from salivary glands, gastric juice, hepatobiliary, and
enteric secretions. These fluids will accumulate and ultimately cause abdominal distension, pain, and
nausea. Eventually, the fluids will build up sufficiently to put the patient at risk for aspiration as they
suffer from nausea that will progress to emesis [2]. This review, therefore, focuses on indications,
insertion techniques, confirmation of placement, complications, outcomes, and recent advances of
nasogastric tubes, which are essential in various medical disciplines.

Compliance with ethics guidelines: This article is based on previously conducted studies and does not
contain any new studies with human participants or animals performed by any of the authors.

Indications and Contraindications

Most commonly, nasogastric tubes are used for gastric decompression in operating rooms during the
administration of anesthesia and in the presence of distal bowel obstruction to prevent pulmonary
aspiration. Distal obstruction can occur as a result of several causes such as ileus, hernias, volvulus,
neoplasms, secretions, or intussusception [1]. The most common nasogastric tube for decompression is
a double-lumen tube with a large and a small lumen. The larger lumen is used for suction while the
smaller lumen acts as a sump allowing air to enter the system, so the suction tube does not adhere to
the wall of the stomach or collapse.

Nasogastric tubes are also often placed in patients with gastrointestinal (GI) bleeding where it may aid in
the diagnosis [3]. The outcomes of patients’ with GI bleed have not shown to be improved with the
placement of a nasogastric tube [4]. There are different types of nasogastric tubes that have been
designed depending on the purpose intended. When nasogastric tubes are used for the delivery of
medications or for short-term nutritional support, a single-bore small-lumen tube such as a Levin or
Dobhoff tube can be used. Both Levin and Dobhoff tubes have a small lumen; however, the Dobhoff has
a weight attached to the distal end to aid in insertion past the pylorus [5].

Basilar skull fractures of facial trauma, esophageal tumors causing esophageal obstruction and
esophageal trauma, and presence of ingestion of caustic substances are all contraindications to the
placement of a nasogastric tube [6]. A relative contraindication is anticoagulation. Placement with
endoscopy is recommended for patients with abnormal GI anatomy, hiatal hernia repair, and prior gastric
bypass surgery [7].

Determination of the Internal Length of a Nasogastric Tube

Blind placement of a NGT for gastric decompression/aspiration prevention is often done intraoperatively.
It is also done for diagnostic reasons, medication administration, and nutrition. In an adult,
approximately 55 cm of the nasogastric tube must be inserted from the nares to reach the center of the
stomach [1]. Accidental intestinal or intraesophageal placement of NGT can result in serious
complications; therefore, to achieve good gastric positioning and avoid complications, accurate
determination of the internal length of the nasogastric tube prior to placement is essential. Historically,
the nose-earlobe-xiphoid distance (NEX) has been used to estimate the insertion length of nasogastric
tubes to obtain correct tip positioning usually 3–10 cm under the lower esophageal sphincter. When
verification of tip positioning was done by x-ray in a comparison study of NEX with corrected NEX or
corrected NEX (NEX × 0.38696 + 30.37) for tube positioning, both methods resulted in incorrectly placed
tubes, which could increase the risk of pulmonary aspiration or reflux [8]. Another common method is to
loop the NGT over the patient, bring the tip over the patients’ xiphoid process, and measure the
estimated length of the NGT to be inserted [8]. A systematic review of 12 papers evaluating the accuracy
of the methods to determine the internal length of NGT in adult patients was performed by Torsy et al.
[9]. Using the methods described to determine the internal length of NGT with blind placement had <
100 percent accuracy. The authors concluded blind placement of NGT is not safe without the position of
the NGT tip being verified by radiologic imaging.

NGT Insertion

Nasogastric tubes are most commonly placed by blind insertion of the NGT through the nose with the
patient’s head in the neutral position without external manipulation of the larynx or instrumental
assistance. Blind insertion is often associated with complications of coiling, kinking, and malposition in
0.5–16% of cases and can result in pleural, pulmonary, and tracheal malposition in 0.3–15% of cases
leading to serious complications of pneumothorax and pulmonary abscess formation [9].

Different success rates have been reported with the insertion of NGT by other techniques. Gao-wen et
al. [10] conducted a meta-analysis of 17 randomized controlled trials with 2500 participants comparing
insertion times, success rates, and complications in anesthetized and intubated patients using different
methods of insertion of NGT. These methods included lateral neck pressure alone [11], lateral neck
pressure in combination with neck flexion [12], use of a frozen NGT [13], video-assisted and other
endotracheal tube guided methods [14], and the reverse Sellick maneuver [15]. In Table 1, we further
elaborate on the methods studied in references [11–15]. The reverse Sellick maneuver entails gentle
pressure to the anterior neck in an anterior direction at the level of the cricoid cartilage. Gao-wen et al.
[10] concluded that compared to the conventional method, all modified techniques of insertion of NGT
resulted in a significantly better first attempt success rate of NGT insertion [10]. In intubated or obese
patients, insertion of NGT using a wire rope could be beneficial. Sharifnia et al. [16] studied the use of a
wire rope guide with chin lift compared to a control group with head flexion as techniques for the
insertion of NGTs. They found that there was significantly higher first attempt success in the rope wire
guide group for correct positioning. The rope wire guide group had a lower incidence of injury, such as
coiling, kinking, and bleeding, related to the procedure.
Table 1.

Success rates of various insertion techniques for NGT placement

Study NGT insertion groups Patients, n Technique Outcome measure Conclusion drawn

Vijay A = control A = 40 A = lubricated NGT Statistical Both techniques

Siddhartha et insertion through a nostril significance from were better than th
al. [11] with a neutral head control not conventional
position discussed method. The revers
A randomized
Sellick's maneuver t
comparative First attempt
B = lateral neck flexion B = 40 B = lubricated NGT was insert NGT is a bette
study success rate:
inserted through nostril to alternative to the
a depth of 10 cm. Lateral A = 37.5% conventional
neck pressure was applied method of NGT
at ipsilateral side as nostril B = 40% insertion
with the neck flexed C = 77.5%

C = reverse Sellicks C = 40 C = anterior displacement Three attempts or

(lifting) of the cricoid greater (i.e. Fail)
cartilage was done to rate:
facilitate NGT insertion
A = 25%

B = 22.5%

C = 7.5%

Mean insertion
time ± SD
(seconds):

A = 25.55 ± 4.52

B = 20.48 ± 4.69

C = 13.05 ± 2.57

Appukutty et A = control A = 50 A = lubricated NGT First attempt Head flexion with

al. [12] insertion through a nostril success rate: lateral neck pressur
with a neutral head is the simplest
A randomized A = 34%
position technique of NGT
controlled
B = 66%* insertion that has
trial
B = ureteral guidewire B = 50 B = a ureteral guidewire the highest success
introduced within a 14-F C = 82%* rate and lowest
NGT until the tip of the D = 82%* incidence of
guidewire met the tip of complications
the NGT. Tube insertion Three attempts or
Study NGT insertion groups Patients, n Technique Outcome measure Conclusion drawn

was then performed the

same method as the
control group

C = slit endotracheal C = 50 C = the NGT inserted

tube through a nostril and
taken out through the
mouth, leaving at least
10 cm of NGT at the
nostril. Then passed
through a longitudinally
cut 7.0-mm ETT, so the tip
of the NGT was at the
level of the Murphy eye.
The ETT was inserted
blindly into the oral cavity
to a depth of 18 cm and
greater (i.e. Fail)
the NGT advanced further.
Rate:
The NGT was then freed
from the ETT, the ETT A = 28%
removed, and the NGT
B = 8%*
passed into the esophagus
C = 8%*
D = neck flexion with D = 50 D = lubricated NGT
lateral pressure inserted through the D = 6%*
nostril to a depth of Mean insertion
10 cm. The patient's neck time ± SD
was flexed, lateral neck (seconds):
pressure was applied, and
the NGT advanced via the A = 56 ± 36
same method as the
B = 42 ± 29
control group
C = 98 ± 43*
Chun et al. A = control A = 50 A = head held in neutral Two attempts or Freezing the NGT
[13] position with head fewer success rate: with distilled water
elevation of 5-10 cm by can increase the
A A = 58%
pillow. Lubricated NGT success rate of NGT
randomized,
gently inserted via nostril B = 88%* insertion
controlled
and withdrawn if
trial Mean insertion
significant resistance felt
or if noted kinking in time ± SD
mouth occurred (seconds):
Study NGT insertion groups Patients, n Technique Outcome measure Conclusion drawn

B = frozen NGT B = 50 B = NGT was carefully A = 120 ± 133

opened to maintain
B = 83 ± 43
natural curvature and
injected with sterile,
distilled water and then
frozen prior to following
the same insertion steps
as control

Kim et al. [14] A = control A = 35 A = NGT insertion through First attempt In intubated
a nostril to the larynx and success rate: anesthetized
A randomized
then gently inserted while patients, use of a
clinical study A = 37.1%
the cuff of the GlideScope with
endotracheal tube was B = 100%* modified Magill
loosened and the jaw was forceps will shorten
gently pulled up slightly Three attempts or the insertion time
fewer rate: and improve the
B = GlideScope + Magill B = 35 B = GlideScope insertion A = 74.3% success rate of
forceps into the mouth to placing an NGT
maximally visualize the B = 100%*
esophageal entrance, and Mean insertion
modified Magill forceps time ± SD
were used to direct the (seconds):
NGT towards the
visualized esophageal A = 96.7 ± 57.5
opening. Then the same
B = 71.3 ± 22.6*
steps as the control group
were followed Mean insertion
attempts ± SD

A = 2.11 ± 0.93

B = 1.0 ± 0.0*

Mandal et al. A = control A = 50 A = lubricated NGT First attempt The reverse Sellick's
[15] insertion through a nostril success rate: maneuver, neck
with a neutral head flexion with lateral
A A = 56%
position neck pressure, or
prospective,
B = 65% guide wire-assisted
randomized
B = ureteral guidewire B = 49 B = a 6-F ureteral techniques are
controlled C = 75%*
guidewire introduced superior alternative
trial
within a 14-F NGT until D = 86%* to conventional
the tip of the guidewire
Study NGT insertion groups Patients, n Technique Outcome measure Conclusion drawn

met the tip of the NGT.

Tube insertion was then
performed the same
method as the control
group

C = neck flexion with C = 49 C = lubricated NGT

lateral pressure inserted through the
nostril to a depth of
10 cm. The patient's neck
was flexed, lateral neck
Three attempts or method for NGT
pressure was applied, and
greater (i.e. fail) insertion in
the NGT advanced via the
rate: anesthetised,
same method as the
intubated adult
control group A = 30%
patients
D = reverse Sellick's D = 49 D = anterior displacement B = 12%*
maneuver (lifting) of the cricoid C = 10%*
cartilage was done to
facilitate NGT insertion D = 4%*

Mean insertion
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*Indicates statistically significant difference from control (p < 0.05)

Unconscious patients are unable to cooperate with the operator in NGT placement, making insertion
even more challenging. Commonly reported impaction sites on insertion of a NGT in unconscious
patients are the arytenoid and the piriform sinus [17]. In a prospective, parallel, randomized, double -
blind control trial involving 110 unconscious patients, Wangmiao Zhao et al. [17] found that backward
displacement of the tongue was the first impaction site to block the pharyngeal passage in unconscious
patients. Furthermore, the success rate was higher and the complication rate and intubation time were
lower for NGT placement in patients positioned in the lateral decubitus versus supine position.
Manipulation of NGT into the esophagus by indirect visualization has been described by Sahu et al. [18]
using video laryngoscopy. Sahu et al. [18] described NGT placement in intubated and anesthetized
patients using video laryngoscopy with glide scope and forward placement by external laryngeal
maneuver with high success and with less time. Guidance of the NGT by other means, such as
endoscopic, direct surgical with fluoroscopy, or electromagnetic guidance, can also be pursued.
Guidance with fluoroscopy achieves about 90%success rate [19].

Confirmation of Nasogastric Tube Placements

NGTs are needed in patients who are mechanically ventilated and in some non-ventilated patients, and
confirmation of gastric position is paramount [20]. Confirmation of the position of a NGT can be
accomplished in several ways. The gold standard for confirmation of NGT is chest x-ray. The other modes
of confirmation with less accuracy are pH analysis and end tidal CO2 (ETCO2) detection. Studies to
measure the ETCO2 and pH to determine the threshold values to potentially improve the positioning of
NGT correctly are ongoing [21]. Taskiran et al. [22] did a methodologic study to evaluate the
effectiveness of auscultatory, pH measurement methods and calorimetric capnography for the
confirmation of NGT placements [22]. It was determined that all three methods were unreliable to
confirm the correct NGT placement; the authors recommended that initial placement of the NGT
continues to be confirmed by radiography.

However, confirmation of correct NGT placement by radiologic means is not always possible. This has
especially been seen since the start of the COVID-19 pandemic, where frequent NGT evaluations were
needed for the prone ARDS patients in the intensive care units (ICU). In these cases, ultrasound has been
considered an alternative method with good sensitivity and specificity [23]. Vasiliki et al. [23] used
ultrasound confirmation of NGT placement with sagittal and longitudinal epigastric views in a
prospective study of 276 COVID-19 ARDS patients. Ultrasonic evaluations were done in the ICU at initial
NGT placement in 89.1% of patients, after change in patient positions to prone or supine, or when
requested by the ICU team. In one of the ultrasound confirmatory tests, the NGTs could be visualized
directly by the presence of two parallel lines in 69.9% of patients. The other ultrasound confirmatory test
was the “whoosh” test where a flash could be seen with ultrasound when air was insufflated into the
NGT in 69.9% of the patients. The full evaluation for confirmation of the NGT was done in 3.8 ± 3.4 min,
with 98.9% sensitivity and 57.9% specificity. With the need for frequent changes in position several times
a day in ARDS patients, ultrasound confirmation of correct NGT placement is a feasible and practical tool.

Behera et al. [24] studied NGT tip localization in anesthetized and intubated adult patients using flexible
video bronchoscopy. During endoscopy, insufflation of 2 l oxygen through the working channel was
helpful in opening of the esophagus. Repeated suctioning was also performed to prevent gastric
distension by the insufflation of oxygen. The authors describe the visualization of the entire NGT in the
esophagus and stomach using this method. The traditional confirmation by radiography of the position
of the NGT was also performed. In patients when radiography is not clear to determine NGT position,
use of a flexible video bronchoscope can be advantageous.

Point-of-care ultrasound (POCUS) has been used for confirmation of blindly placed NGTs. However,
complications continue to occur during the blind placement, including aspiration pneumonias,
pneumothorax, intracranial placement, right atrial placement, and even death [25–27]. A randomized
control trial using real-time POCUS-guided NGT insertion [28] had high first attempt success rate, high
sensitivity (over 90%) in intubated and non-intubated patients, and significantly decreased passage
related complications. A confirmatory radiograph is not necessary when performing POCUS-guided NGT
insertion [24, 28].

In summary, health care institutions should develop their own standard procedures for insertion and
confirmation of nasogastric tube placement based on the best available evidence [29]. More research is
needed on the development of reliable and effective non-radiologic methods applicable for use at the
bedside.

Securement of Nasogastric Tubes

Several factors affect the outcomes of NGT efficacy, including the method of securing of the NGT. This is
especially important in children and adults with comorbidities and age-related illnesses. Other important
factors are the length of stay, prior NGT dislodgments, radiographic exposures, adverse skin outcomes,
and emergency department (ED) encounters. In adult patients, nasal bridles, devices that wrap around
the vomer bone of the nose and clasp the NGT at a desired depth, have been shown to be a safe and
effective method to secure a NGT to the nares. In the pediatric population, nasal bridles have not
historically been used as widely [30]. Use of nasal bridles to secure NGT compared to standard securing
with tape have been studied in children by Lavoie et al. [30], and bridles were found to have fewer NGT
dislodgements, radiographic exposures, ED visits, and hospital days [30]. Securing NGT in intubated
patients in both adults and children requires considerable attention [31]. Figure 1 shows proper
placement of a nasal bridle.

Fig. 1.
Open in a new tab

Placement of nasal bridle. a Insertion of probe. b Insertion of catheter and probe. c Magnet
connection. d Cut catheter from umbilical tape. e Nasal tube and umbilical tapes. f Umbilical tape knot
with clip over nasotube

Complications of NGT Placement

According to the literature, 2–36% of NGT placements have complications during insertion and removal
[1, 32]. The complications include bleeding, kinking, coiling, misplacement, and potential knotting of the
NGT. A case report describes the stocking of a knotted nasogastric tube with a hard and granny tie in the
nasopharynx. The tube was successfully removed with a pediatric bougie [33].

Misplacement of a NGT is a complication that can be recognized by radiography. In addition to diagnosis

of a misplaced NGT, radiography can also help in the planning of a safe removal of the misplaced NGT
[34]. Misplacement of a nasogastric tube can occur inadvertently into the pulmonary system. This can
lead to major complications including aspiration and respiratory distress [35]. Fourteen guidelines to
distinguish pulmonary from gastric placements of NGT were explored. These methods for tube
placement testing included radiography, aspirate appearance, respiratory distress, auscultation, enteral
access devices, carbon dioxide detection, and aspirate pH. The most accurate testing method was
radiography [36].

NGT can cause pressure injury of the nares especially over prolonged use as is often seen in the ICU. An
organizational process improvement model was implemented as an intervention to decrease the
hospital-acquired pressure injuries related to NGT in a metropolitan hospital with success. The
intervention included the creation and implementation of specific and clear guidelines to assess and
secure NGT [37]. A simple mnemonic “CLEAN” was used to implement the guidelines. The mnemonic
denoted: correct tube position, stabiLize tube, Evaluate area near/under tube, Alleviate pressure, and
deNote date and time. After the guidelines were implemented, the incidence of NGT-related hospital-
acquired pressure injury decreased significantly when followed for 1 year. Prolonged use of the NGT can
result in gastric bleeding by gastric irritation [38]. It is vital to follow evidence-based recommendations
for NGT placement to improve clinical outcome [39].

NGT and Nutrition

There has been much interest in the importance of early postoperative nutrition. Complications of
nasoenteral feeding include aspiration, diarrhea, sinusitis, nasopharyngeal lesions, derangements in
metabolism, and intestinal ischemia without significant advantage over gastroenteric feeding [40].
Nasoenteral tubes can be placed post-pyloric—past the stomach and in the small intestine—in contrast
to the nasogastric tube, which terminates in the stomach [41].

When the oral route is unsafe or not sufficient, enteral nutrition with the use of nasogastric tube in the
short term (about 2 weeks) can be used. The fine-bore, flexible nasogastric feeding tube has been used
in elderly patients > 65 years of age with malnutrition or dysphagia [42] as a short-term solution for
enteral feeding. This method has been seen to provide benefit to prevent malnutrition but has risk of
dislodgement and potential delay in utilizing the NGT while awaiting placement confirmation by x-ray
[43, 44].
Patients with chronic dysphagia or severe swallowing disturbances, such as those with cancer, dementia,
stroke, and head injury, are often given a long-term NGT for nutritional support. There is a dearth of
epidemiological data for use of long-term NGT. A study in Taiwan done by Chung Hsu et al. [45] showed
that long-term NGT placement was associated with higher risk of mortality and comorbidities such as
acute and chronic respiratory illnesses, especially in stroke patients. In acute stroke patients, it is
common to use a NGT as the patients often have decreased consciousness and related dysphagia. NGTs
in such patients are most often used for feeding. Another study in acute stroke patients by Rabaut et al.
[46] revealed that multiple serious complications could occur with the use of NGT. These included
aspiration pneumonia (49.2%), multiple insertion attempts, failed insertions, reinsertions, placement in
the wrong positions, resistance, kinking or coiling of NGT, pneumothorax, and death in 36.4% of patients
during the hospital admission. It is prudent to include these findings in discussions with families
regarding NGT for nutritional support [47, 48]. Implementing nasoenteral feeding tubes such as Dobhoff
tubes for longer than immediate use has provided safe and beneficial nutritional support in patients with
head and neck cancer in the presence of dysphagia or odynophagia in a retrospective study on 444
patients needing radiation therapy for head and neck cancer. There was a significant decrease in the
median weight after Dobhoff was placed during treatment [5].

Patients needing > 30 days (long-term) nutritional support with inadequate swallowing can benefit from
a percutaneous endoscopic gastrostomy (PEG) [49]. PEG tubes have been described to last for 1–2 years
[50]. There is not agreement on how long a NGT can remain in place for prior to exchanging it to a
gastrostomy [51]. Studies have suggested that there is no significant difference in mortality rates or
adverse events like aspiration pneumonia when comparing NGT with gastrostomy. PEG is associated with
lower rates of intervention failure [52]. Long-term jejunal feeding can be by direct percutaneous
endoscopic jenunostomy (DPEJ) or with high success rates with the help of jejenal tubes through the PEG
(JET-PEG) [53]. Enteral feeding is more physiologic than parenteral feeding and has better outcomes
including reduced septic complication [47] along with decreased costs [48]. New designs which could
lead to the development of dual purpose nasogastric and nasojejenal tubes to improve nutrition care are
in progress [54].

Currently, PEG tube is considered the gold standard for long-term enteral nutrition [55]. The European
Society for Clinical Nutrition and Metabolism (ESPEN) [56, 57] and the European Society of
Gastrointestinal Endoscopy (ESGE) [58, 59] have recently published guidelines that focus on several
topics of enteral nutrition and endoscopy to structure and standardize enteral nutrition to optimally
manage patients.

Conclusion

NGT placement, though relatively routine, must be performed effectively and safely to avoid the
associated complications [39]. After blind placement of the NGT, the position and tip must be confirmed
by radiography. Recent advances indicate that in the acute care setting POCUS could be used for
insertion of NGT when expertise is available at the bedside. This has been demonstrated to be
particularly useful in ICU settings in patients with COVID-19. Patients with good intestinal absorptive
capacity but who are unable to ingest food orally could consider the options of endoscopic enteral
feeding access. Current NGTs on the market often present challenges for continued gastric
decompression during post pyloric enteral feeding or as postoperative nasogastric enteral feeding tube.
Design and research of dual purpose nasogastric and nasojejunal tubes to improve nutrition care and
patient safety are in progress. The European Society for Clinical Nutrition and Metabolism (ESPEN) and
European Society of Gastrointestinal Endoscopy (ESGE) offer useful guidelines to structure and
standardize enteral nutrition more seamlessly.

Acknowledgements

Funding

No funding or sponsorship was received for this study or publication of this article.

Author Contributions

Nalini Vadivelu, Gopal Kodumudi, Lisa R. Leffert, Doris C. Pierson , Laura K. Rein, Matthew S. Silverman,
Elyse M. Cornett, and Alan D. Kaye contributed towards study concept and design, analysis and
interpretation of data, drafting of the manuscript, and critical revisions of the manuscript for important
intellectual content and statistical analysis.

Disclosures

Nalini Vadivelu, Gopal Kodumudi, Lisa R. Leffert, Doris C. Pierson, Laura K. Rein, Matthew S. Silverman,
Elyse M. Cornett, and Alan D. Kaye have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human
participants or animals performed by any of the authors.

Contributor Information

Nalini Vadivelu, Email: nalini.vadivelu@yale.edu.

Gopal Kodumudi, Email: gkodum@lsuhsc.edu.

Lisa R. Leffert, Email: lisa.leffert@yale.edu

Doris C. Pierson, Email: doris.pierson@yale.edu

Laura K. Rein, Email: laura.rein@yale.edu

Matthew S. Silverman, Email: matthew.silverman@yale.edu

Elyse M. Cornett, Email: elyse.bradley@lsuhs.edu

Alan D. Kaye, Email: alan.kaye@lsuhs.edu

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