Retrospective endoscopic assessment of complications associated with nasogastric intubation in horses at a referral hospital.

Subclinical nasogastric intubation complications occur in ~27% of endoscopically examined horses, with smaller horses at greater risk.

This retrospective study characterized endoscopically confirmed complications following nasogastric intubation (NGI) in horses at a referral institution over a four-year period. Of 94 horses that underwent endoscopy within three days of receiving at least one NGI, 25 (26.6%) had endoscopically identified complications. Notably, 68% of these complications were subclinical—identified incidentally during endoscopy performed for unrelated reasons. Complications were anatomically categorized as nasopharyngeal, esophageal, or gastric. Nasopharyngeal complications were most likely to produce clinical signs (60%), followed by esophageal (33%), while gastric complications produced no clinical signs (0%). Key risk factors associated with complications included lower body weight (median 430 kg vs. 518 kg in non-complicated horses) and elevated band neutrophil counts, suggesting an inflammatory response or underlying systemic illness may predispose horses to injury. Importantly, factors such as pre-referral intubation, total number of intubations, and presence of an indwelling tube were not statistically associated with complication occurrence. These findings suggest that smaller horses may warrant additional caution during NGI procedures. Clinical complications requiring intervention were uncommon, supporting the relative safety of routine NGI. However, the substantial proportion of subclinical lesions detected endoscopically highlights the potential for unrecognized mucosal trauma. Clinicians should be aware that post-NGI endoscopy may reveal incidental findings, and that lower body weight may serve as a useful flag for heightened procedural care.

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