How can pancreatic enzymes be used to unclog a G (gastrostomy) tube?

Using Pancreatic Enzymes to Unclog a Gastrostomy Tube

If water flushing fails to clear a clogged G-tube, instill pancreatic enzyme solution, which successfully reopens approximately 50% of occluded tubes that did not respond to water alone. 1

Stepwise Approach to Unclogging

Step 1: Initial Water Flush

• Attempt flushing with 40-60 mL of warm water using gentle pressure to avoid tube damage 2, 3
• Position the patient upright to minimize aspiration risk 2
• This simple intervention clears approximately one-third of obstructions 1

Step 2: Pancreatic Enzyme Installation (If Water Fails)

Prepare the enzyme solution by mixing pancreatic enzymes with sodium bicarbonate to create an alkaline solution (pH 7.5), which achieves a 96% success rate in clearing formula-related clogs. 2, 4

Specific Preparation Method:

• Use a 5-mL suspension containing: lipase 2000 FIP units, amylase 1500 FIP units, and protease 100 FIP units 5
• Add 90 mg of sodium bicarbonate (NaHCO₃) to maintain pH 7.5 5
• The alkaline environment is critical—acidic solutions like cranberry juice or carbonated beverages are inferior and should be avoided 1, 3

Administration Technique:

• Insert a Drum cartridge catheter into the occluded tube to displace liquid formula and apply the enzyme solution close to the obstruction 4
• Allow the enzyme solution to dwell in the tube for 15-30 minutes to break down protein-based formula clots 4, 6
• Flush with water after the dwell time 4

Step 3: Mechanical Devices (If Enzymes Fail)

• Use Fogarty balloon catheter, biopsy brush, or commercially available tube decloggers only after enzymatic treatment fails 1, 2
• These mechanical approaches carry higher risk of tube damage 2

Step 4: Tube Replacement (Last Resort)

• Replace the tube only after all other methods have failed 1, 2
• Most transoral bumper-type gastrostomy tubes can remain in place for 1-2 years with optimal care 1

Evidence Quality and Nuances

The recommendation for pancreatic enzymes is supported by both high-quality guidelines from the Society of Interventional Radiology and American Gastroenterological Association 1 and research demonstrating 72-96% success rates when formula clotting is the cause 4. The alkaline pH is essential—the enzymes work by breaking down protein-based formula clots that form when protein interacts with the acidic gastric environment. 1, 4

Common Pitfalls to Avoid

• Never use carbonated beverages, cranberry juice, or other acidic solutions—these have been shown to be inferior to water and may cause tube degradation 1, 3
• Avoid excessive force when flushing—this can rupture or damage the tube 2, 3
• Do not use hydrogen peroxide for tube cleaning—it can irritate the skin and contribute to stomal leaks 1
• Recognize that pancreatic enzymes will not clear obstructions caused by tablet impaction, knotted tubes, or foreign bodies—these require mechanical intervention or replacement 4

Prevention Strategy

Prophylactic use of pancreatic enzyme-sodium bicarbonate suspension (pH 7.5) after routine water flushing reduces tube occlusion rates from 23.5% to 2.6%. 5

• Flush with 40 mL of water before and after every feed or medication administration 2, 3
• Consider prophylactic enzyme installation after water flushing in high-risk patients 5
• Use liquid medications when possible rather than crushed tablets 3
• Clean the tube daily with water and regular or antibacterial soap 1