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. Various sources continue to reiterate the potentially serious complications with this procedure. Trends toward evidence-based medicine and the growing body of experimental and clinical data point 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 (e.g., activated charcoal) has further limited the role of gastric lavage.1,3 The American Academy of Clinical Toxicology (AACT) states that “gastric lavage should not be performed routinely, if at all, for the treatment of poisoned patients.”4
ANATOMY AND PATHOPHYSIOLOGY
The administration of activated charcoal is the current decontamination measure of choice. There remain very few indications for performing gastric lavage. These indications include a highly toxic or potentially lethal ingestion presenting acutely where no antidote exists, no antidote is available, or other usual therapies are ineffective. Gastric lavage has never been demonstrated to decrease mortality or improve the final outcome of the patient. The decision should be made with consideration to the specifics of the individual case.
The optimal timing to perform gastric lavage is controversial. The efficacy of gastric lavage diminishes rapidly over time. Any benefit of gastric lavage would likely be gained if performed promptly and within 1 hour of an oral ingestion.3 Authors agree that sooner is 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 Delayed gastric lavage should be considered only in a severe poisoning where delayed gastric emptying is suspected. Some toxicants or co-ingestants (e.g., anticholinergics or opioids) may cause delayed gastric emptying, whereas others may form masses or concretions in the stomach. Removal of a percentage of the ingested dose may theoretically lessen the severity of the poisoning in some cases, but these benefits remain unproven.
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. Nasogastric tubes should be limited to liquid overdoses. Lavage fluid that does not return ...