Unclogging enteral feeding tubes: A systematic review

Enteral feeding tube occlusion is a significant complication that impairs treatment efficacy and increases patient risk. Although various interventions exist, a gap remains regarding their comparative effectiveness. This systematic review synthesizes evidence on the relative efficacy of water flushes, enzymatic agents, and mechanical devices for resolving occlusions.

A search of PubMed, Cochrane Library, Scopus, ScienceDirect, and ClinicalTrials.gov was conducted following PRISMA 2020 guidelines to identify relevant in vivo and in vitro studies.

Of 1845 records identified, eight studies were included. Mechanical interventions demonstrated high rates of success; an actuated mechanical device cleared 93% of in vitro clogs, significantly outperforming enzyme treatments (33%) and warm water flushes (20%). A non-actuated Fogarty catheter also cleared 100% of resistant clogs in a case series. Regarding enzymes, alkalinized non-enteric-coated pancreatic enzyme solutions achieved a 63.5% success rate, significantly superior to enteric-coated granules (48.2%) and reaching 96% for formula-based clogs. Conversely, warm water flushes demonstrated limited efficacy (20%-27%).

While actuated mechanical devices demonstrate the highest in vitro efficacy, alkalinized non-enteric-coated pancreatic enzymes are highly effective, particularly for formula clogs. Despite the low certainty of evidence, results support a sequential algorithm: a first-line attempt with warm water, followed by escalation to an actuated mechanical device or an alkalinized non-enteric-coated pancreatic enzyme solution.