Serious complications associated with nasogastric, orogastric or enteral tube misplacement over the decades: a systematic review

Background: Gastrointestinal tube (GIT) insertion is common in surgical, medical and intensive care unit settings, with approximately 170,000 annual insertions in the UK alone. Despite its apparent simplicity, GIT placement can lead to acute complications, ranging from mucosal lesions to life-threatening conditions. Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching on PubMed, Cochrane, EMBASE and Scopus, all case reports and series describing harm from nasogastic, orogastric, or enteral tube placement. Results: A total of 148 studies reported acute GIT complications in 168 patients (70 patients received an enteral feeding tube). The number of publications increased over time. Half (91 patients, 52%) of the displacements involved the respiratory tract, but other organs were also affected, including the brain (33 patients, 20%), gastrointestinal tract (23 patients, 14%) and intravascular system (6 patients, 4%). Brain misplacement had the highest mortality (60.6%), while for respiratory tract misplacement mortality was 20.9%. Mortality was high in emergency department procedures and acute trauma, while it was low when enteral feeding tubes were involved. Only 30% of the manuscripts reported adherence to guidelines, which was associated with a trend towards decreased mortality. Conclusions: Our findings identify an increasing reporting of GIT misplacement complications and emphasize a variety of involved anatomical sites, from the well-known brain, respiratory tract, and pleural space mispositioning, to gastrointestinal and abdomen perforation, to the extremely uncommon spleen and intravascular mispositioning. The importance of implementing standardized protocols and maintaining heightened clinical vigilance is crucial to mitigate complications related to GIT misplacement. The PROSPERO Registration: PROSPERO CRD42024491074.