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The placement of an orogastric tube is confirmed primarily through X-ray confirmation because this method provides a definitive visual check of the tube’s placement within the stomach. X-rays can show the location of the tube and help ensure that it is positioned properly, which is critical to avoid complications such as aspiration, where the tube may be misdirected into the lungs instead of the stomach.

While other methods like visual inspection and clinical assessment may offer initial indications about the tube's placement, they do not provide the level of accuracy and reliability that X-ray confirmation does. Endoscopy is typically used for direct visualization of internal structures rather than as a routine procedure to confirm the placement of an orogastric tube. Therefore, X-ray confirmation remains the standard for ensuring that the tube is correctly positioned for safe and effective usage in medical settings.