EBM Consult

Nasogastric Tube (NGT) vs. Non-NGT Conservative Treatment of Confirmed Adhesive Small Bowel Obstruction (SBO) to Reduce Need for Surgery


  • P = Patients with confirmed adhesive small bowel obstruction (ie: confirmatory imaging)
  • I = NGT placement
  • C = Non-NGT conservative treatment (NPO, IV fluids, symptom control)
  • O = Reduce the need for surgery
  • T = Acute care setting
  • S = During ED stay and inpatient admission

Note: PICOTS stands for (P) for patient, (I) for intervention of interest, (C) for comparison, (O) for outcome of interest, (T) for timing, & (S) for setting.

Take Home Point(s):

  • Nasogastric decompression is recommended for all patients undergoing conservative (non-operative) management for the management of small bowel obstruction.
  • The data supporting nasogastric decompression is largely from studies comparing it to long-tube decompression.
  • Nasogastric decompression has not been associated with lower rates of surgery in retrospective reviews.

Adhesive small bowel obstruction (ASBO) is a condition wherein adhesions from prior surgeries externally compress the small bowel leading to obstruction and, if not treated, significant morbidity and mortality. Diagnosis of ASBO is based on the patient presenting symptoms with confirmatory imaging interpreted by a board-certified radiologist. Certain guidelines for treatment for ASBO recommend placement of NG tubes for patients who do not go to emergent surgery (either for signs of peritonitis or strangulation) as part of conservative management, while others do not discuss the use of NG tubes in nonoperative treatment. Indications for NG tube placement are to decompress the stomach to reduce emesis and subsequent aspiration risk. The guideline recommendations are based on studies comparing the use of nasogastric decompression to long-tube decompression (an endoscopically placed naso-jejunal tube used for decompression outside of the US) in reducing surgical intervention.

The current literature does not suggest a reduction in surgical intervention in patients receiving nasogastric decompression in ASBO. Unfortunately, because of the retrospective designs of these studies, there isn’t enough evidence to support stopping the use of nasogastric decompression altogether. Therefore, emergency physicians should continue to use nasogastric decompression for patients with significant nausea, vomiting, and distension while discussing the need for NGT placement with their surgical consultants.

Author: Lakshmi R. Kirkire, MD (Johns Hopkins School of Medicine)
Editors:  Phil Magidson, MD (Johns Hopkins School of Medicine) and Edana Mann, MD (Johns Hopkins School of Medicine)  
Editor-in-Chief: Anthony J. Busti, MD, PharmD, MSc, FNLA, FAHA
Date Last Reviewed:  March 2023

Supporting Guideline Statements

  • WSES (World Society of Emergency Surgery) Working Group on ASBO (Adhesive Small Bowel Obstruction.
    “Patients without the signs of strangulation or peritonitis or history of persistent vomiting or combination of CT scan signs (free fluid, mesenteric edema, lack of feces signs, devascularized bowel) and partial ASBO can safely undergo non-operative management (LoE 1a GoR A). In these patients tube decompression should be attempted (Level of Evidence 1b GoR A), either with NGT or LT.”

  • Eastern Association for the Surgery of Trauma (EAST).
    “1. Patients with SBO and generalized peritonitis on physical examination or with other evidence of clinical deterioration such as fever, leukocytosis, tachycardia, metabolic acidosis, and continuous pain should undergo timely surgical exploration. Level 1.
    2. Patients without the previously mentioned clinical picture can safely undergo initial nonoperative management for both partial and complete SBO, although complete obstruction has a higher level of failure. Level 1”


  • Dong XW et al. Nasointestinal tubes versus nasogastric tubes in the management of small-bowel obstruction: A meta-analysis. Medicine. 2018;97(36):e12175.  PubMed

Original & Supporting Clinical Trials

  • Chen XL, et al. A prospective randomized trial of transnasal ileus tube vs nasogastric tube for adhesive small bowel obstruction. World J Gastroenterol. 2012 Apr 28;18(16):1968-74. PubMed

  • Fleshner PR, et al. A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction. Am J Surg. 1995 Oct;170(4):366-70.  PubMed

Supporting Studies

  • Berman DJ, et al. Nasogastric decompression not associated with a reduction in surgery or bowel ischemia for acute small bowel obstruction. Am J Emerg Med. 2017 Dec;35(12):1919-1921. PubMed

  • Fonseca AL, et al. Routine nasogastric decompression in small bowel obstruction: Is it really necessary? Am Surg. 2013 Apr;79(4):422-8.  PubMed

  • Shinohara K, et al. Nonoperative management without nasogastric tube decompression for adhesive small bowel obstruction. Am J Surg. 2022;223(6):1179-1182. PubMed

Article Citation

  • Kirkire, LR. Nasogastric Tube (NGT) vs. Non-NGT Conservative Treatment of Confirmed Adhesive Small Bowel Obstruction (SBO) to Reduce Need for Surgery. Magidson P, Mann E, Busti AJ eds. EBM Consult. March 2023; DOI: https://www.ebmconsult.com/articles/nasogastric-tube-ngt-treatment-adhesive-small-bowel-obstruction-sbo-impact-on-surgery

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  • Nasogastric tube, NGT, Small obstruction, SBO