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Inserting a nasogastric tube (NGT) in intubated patients may be difficult because they cannot follow swallowing instructions, resulting in a high rate of first-attempt failure. We introduce a simple technique for inserting an orogastric tube in an emergency department (ED).Fifty-six patients in the ED, who were intubated and required NGT insertion, were randomly allocated to 2 groups. We inserted the NGT using a conventional technique from the nostril (control group) and an endotracheal tube (ET)-assisted technique from the mouth (ET group). The procedures' success rate, insertion duration, and complications were compared between the groups.There was a significantly higher overall success rate in the ET group than the control group (100% vs 64%, P < .001). Endotracheal tube group showed 100% first-attempt success rate, but 50% of the control group failed at first attempt. Mean duration of the first trial was not significantly different between the ET and control groups (58.0 ± 16.9 vs 57.3 ± 29.5 seconds, P = .903), but total time for successful insertion was longer in the control group than the ET group (58.0 ± 16.9 vs 111.7 ± 74.5 seconds, P < .001). There was less NGT kinking and more mucosal bleeding in the ET group than in the control group (0% vs 16%, P = .019; 16% vs 7%, P = .225, respectively).Endotracheal tube–assisted orogastric tube insertion technique showed a higher rate of successful insertion and shorter total duration. With this result, ET-assisted orogastric tube insertion would be useful in ED.