[Indications and management of nasogastric tube]

. Indications and management of nasogastric tube. The review by Alverdy et al examines current evidence on the indications, placement, and management of nasogastric tubes (NGTs) used for gastric decompression. Historically employed since the 17th century, modern NGTs - particularly the Salem sump - enable effective aspiration while minimizing mucosal injury. The primary indication remains small bowel obstruction, most often caused by adhesions. In uncomplicated cases without ischemia or peritonitis, NGT based conservative management resolves approximately 75% of obstructions. Water soluble contrast agents retain diagnostic value but do not reduce surgical rates.Routine postoperative NGT use after elective abdominal surgery is not supported by evidence. Multiple meta analyses show earlier return of bowel function, fewer pulmonary complications, and shorter hospital stays when NGTs are avoided. Recent trials in pancreatic surgery confirm no benefit from routine decompression and suggest a possible increase in mortality. ERAS protocols across colorectal, gastric, pancreatic, esophageal, hepatobiliary, and gynecologic surgery consistently recommend selective rather than routine use, reserving NGTs for severe distension, refractory vomiting, delayed gastric emptying, or high aspiration risk.Contraindications include facial trauma, caustic ingestion, esophageal perforation, and fixed obstructions; relative contraindications involve coagulopathy, varices, recent upper GI anastomosis, and severe nasal pathology. Proper insertion technique, radiographic confirmation when needed, secure fixation, and daily reassessment are essential. Complications range from nasal trauma and misplacement into the airway to electrolyte disturbances, aspiration, and pressure injuries.Overall, NGTs remain valuable for targeted decompression, but evidence strongly supports selective, time limited use with vigilant monitoring and prompt removal when no longer indicated.