Unclogging enteral feeding tubes: A systematic review

BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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%). CONCLUSION: 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.