Study examines endoscopic complications after equine NG intubation

A new JAVMA retrospective study takes a closer look at a routine equine procedure that can quickly move from lifesaving to injurious: nasogastric intubation. Alexandra S. Fielding and Breanna Sheahan reviewed horses at a referral hospital that had at least one nasogastric intubation within three days before endoscopy, aiming to measure how often complications were actually visible on scope exam and to identify risk factors associated with those lesions. That focus is notable because much of the older literature on equine nasogastric tube injury has centered on obvious clinical cases rather than endoscopically confirmed findings in a broader hospital population. (pubmed.ncbi.nlm.nih.gov)

That background matters. Nasogastric intubation is a standard part of equine colic care, reflux assessment, enteral fluid therapy, and some perioperative management, so most equine clinicians see it as indispensable. But published literature has long documented that the procedure can cause pharyngeal or esophageal trauma, with a classic 1992 JAVMA case series describing nine horses with injury after intubation, including several with perforation and poor outcomes. Other reports have described retained tube fragments, nosocomial sinusitis associated with perioperative intubation, and aspiration-related complications when substances are delivered through the tube. (pubmed.ncbi.nlm.nih.gov)

The new study’s design, as described in the abstract, captures horses scoped between March 2021 and March 2025 after one or more nasogastric intubations in the preceding 72 hours. Investigators collected signalment, history, clinicopathologic data, procedure details, reason for endoscopy, treatment, and outcome to characterize incidence and risk factors. Even without the full paper text available in the search results, the study stands out because it uses endoscopic confirmation rather than relying only on clinical suspicion. That likely means it can detect subclinical or milder lesions that would otherwise be missed in busy hospital practice. This is an inference based on the study design and the known limitations of earlier case-based literature. (beva.onlinelibrary.wiley.com)

The broader literature suggests why that matters. A 2025 Equine Veterinary Education clinical commentary on prolonged nasogastric intubation emphasized the management difficulties and complication risks tied to repeated or indwelling tubes in equine patients. Separately, a 2020 survey of equine veterinarians framed nasogastric intubation as both a patient-safety and occupational-safety issue, noting inconsistent tube disinfection and risky practices such as using the mouth to suck or blow air through the tube. Together, those reports paint a picture of a high-frequency procedure where small technique differences, repetition, and workflow pressures can influence outcomes. (beva.onlinelibrary.wiley.com)

I didn’t find a press release or outside expert quote specifically reacting to this JAVMA paper in the available search results. What I did find is a consistent industry perspective in the existing literature: nasogastric intubation is necessary, but complications are probably more common than many clinicians assume, especially when only the most dramatic injuries get reported. Training research has also shown that veterinary students benefit from simulation models before performing the procedure on live horses, which supports the idea that technique standardization and supervised repetition may be part of prevention. (pubmed.ncbi.nlm.nih.gov)

Why it matters: For veterinary professionals, especially equine hospital teams, this study reinforces the value of treating post-intubation signs as potentially procedure-related until proven otherwise. Horses that show salivation, bruxism, coughing, nasal discharge, dysphagia, fever, or unexplained upper airway changes after tubing may warrant earlier endoscopic evaluation, not just symptomatic management. In referral settings, where horses may be intubated multiple times over a short interval, the findings could also inform decisions about who performs repeat passes, when to switch strategy, how to document difficult intubations, and when to consider preventive changes in sedation, restraint, lubrication, or tube selection. Those workflow implications are supported by the older complication literature and by newer commentary on prolonged intubation. (pubmed.ncbi.nlm.nih.gov)

The study may also have relevance beyond obvious trauma. Because the abstract references endoscopically confirmed complications and risk-factor analysis, it could help define whether some lesions are common but clinically silent, or whether certain horses, indications, or procedural patterns carry disproportionate risk. If so, that would give hospitals a stronger evidence base for protocol changes and client communication with pet parents whose horses require repeated decompression or enteral treatment during hospitalization. (beva.onlinelibrary.wiley.com)

What to watch: The next step is whether the full paper’s incidence figures and risk-factor findings translate into protocol updates at referral centers, including training requirements, limits on repeated blind passes, and clearer triggers for endoscopic recheck after difficult or repeated nasogastric intubation. (beva.onlinelibrary.wiley.com)