Effect of nasogastric tube on pharyngeal swallowing: a prospective paired FEES study in neurogenic dysphagia.

BACKGROUND: NGT feeding is widely used for short-term enteral nutrition in neurogenic dysphagia, but its effect on pharyngeal swallowing physiology is incompletely understood. OBJECTIVE: To evaluate the effect of NGT presence on pharyngeal residue and airway protection using flexible endoscopic evaluation of swallowing (FEES). METHODS: In this prospective before-after study, 53 patients with neurogenic dysphagia and indwelling NGT (≥15 days) underwent FEES with tube in situ and within 30 min of removal, at IDDSI 1, 3, and 5. Residue was graded using the Yale Pharyngeal Residue Severity Rating Scale and airway invasion using the Penetration-Aspiration Scale (PAS); comparisons used Wilcoxon signed-rank and McNemar exact tests. RESULTS: NGT removal significantly reduced vallecular and pyriform sinus residue across all consistencies (p < 0.001; r = 0.600-0.748) and improved PAS (p < 0.001; r = 0.468, 95% CI 0.226-0.655); airway invasion prevalence fell from 37.7% to 15.1%. Invasion resolved in 12/20 patients (60%); none developed new invasion (p = 0.0005). Age was not significantly associated with outcomes. CONCLUSION: Residue and airway safety improved after NGT removal, compatible with an adverse influence of NGT on swallowing, though the fixed-order design cannot establish causality. SIGNIFICANCE: Early reassessment and timely NGT removal, when feasible, may be considered.