Gastric retention is a common complication in individuals receiving enteral nutrition (EN) via a nasogastric tube, increasing the risk of aspiration pneumonia and causing unnecessary interruptions in nutritional support. Given its clinical significance, establishing effective, evidence-based, and standardized management strategies is essential for bettering patient outcomes and mitigating complications. This review systematically synthesized the diagnostic criteria, assessment methods, influencing factors, management procedures, and intervention strategies for gastric retention in EN patients. Although no universal consensus exists regarding gastric residual volume (GRV) thresholds, evidence indicates that EN can continue at high GRV levels in the absence of gastrointestinal symptoms. Bedside ultrasound emerged as a non-invasive, and precise method GRV assessment, offering potential to standardize clinical practice. Key risk factors for gastric retention include neurological disorders and EN infusion rates exceeding 100 mL/h. Effective management strategies encompass non-pharmacological interventions, pharmacological agents, and traditional Chinese medicine (TCM) therapies. This review underscored the need for integrated, multi-modal management strategies and recommended the adoption of bedside ultrasound and standardized protocols to optimize EN delivery and improve patient outcomes. Large-scale, multicenter clinical trials should be a priority for future investigation to verify the effectiveness of TCM therapies and develop personalized intervention plans for high-risk patients.