Gastric lavage is a method of gastrointestinal decontamination, performed in the setting of an acute poisoning by ingestion, to decrease the absorption of substances in the stomach. This technique was first described in 1812 and has been used for nearly 200 years.1 It was repopularized in the 1950s and 1960s and thrived during the heyday of the “tricyclic era” of the 1970s and 1980s. The use of gastric lavage in the Emergency Department has decreased greatly in modern toxicology for several reasons. Most notable is the trend toward evidence-based medicine and the growing body of experimental and clinical data pointing to the limited efficacy of gastric lavage. Gastric lavage was performed in approximately 10.3% of all ED-treated poisoning cases between 1998 and 2003, a decrease from 18.7% during the period of 1993 through 1997.2 The increasing use of other modalities for gut decontamination, especially activated charcoal, has further limited the role of gastric lavage.1,3
With the widespread administration of activated charcoal as the current decontamination measure of choice, there remain very few indications for performing gastric lavage for decontamination, if any. These rare indications would include a highly toxic or potentially lethal ingestion presenting acutely where no antidote exists or where other usual therapies are ineffective, unavailable, or nonexistent.
The optimal timing of gastric lavage is also controversial. Any benefit of gastric lavage would likely be gained if performed promptly and within 1 hour of an oral ingestion.3 Authors agree that the sooner it is instituted, the better. The range of recovered ingestant is highly variable at each time point following an ingestion in volunteer and overdose studies. The trend for mean removal of ingestants is 90% recovery at 5 minutes postingestion, 45% recovery at 10 minutes, 30% recovery at 19 minutes, and as little as 8% recovery at 60 minutes.3
Undoubtedly, the efficacy of gastric lavage diminishes rapidly over time. Some toxicants or coingestants may cause delayed gastric emptying, while others may form masses or concretions in the stomach. Removal of only a small percentage of the ingested dose may theoretically lessen the severity of the poisoning in some cases, but these benefits remain unproven. Gastric lavage has never been demonstrated to decrease mortality. A reasonable approach when considering gastric lavage is in the acutely poisoned patient who presents within 1 hour of a life-threatening ingestion. The decision should be made with consideration to the specifics of the ingestion. Delayed gastric lavage should be considered only in a severely toxic poisoning or where delayed gastric emptying is suspected (e.g., anticholinergic or opioid coingestant). It would be prudent to consult a poison control center or a Medical Toxicologist when considering gastric lavage in any poisoned patient.
Nasogastric placement of a gastric lavage tube is not advised. The orogastric route should be used to avoid traumatic injury to the nasal mucosa, nasal turbinates, and nasal septum. The use of ...