Gastric lavage? Fuggedaboutit!
February 23, 2013, 12:12 am
Position paper update: gastric lavage for gastrointestinal decontamination. Benson BE et al. Clin Toxicol 2013 Feb18 [Epub ahead of print]
The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists published their initial position paper on gastric lavage in 1997, concluding that their was no good evidence supporting the use of the procedure in poisoned patients. A 2004 update reached the same conclusion.
This paper reviewed medical literature appearing since 2003 and found there was no need to alter the groups’ previously stated recommendations. in the last decade, there have been additional papers demonstrating the risks and potential complications of lavage, but none convincingly demonstrating any clinical benefit. Although the groups didn’t completely throw lavage under the bus, they came as close to doing so as one could expect from expert panel consensus. It is important that all emergency practitioners be familiar with their conclusion:
At present there is no evidence showing that gastric lavage should be used routinely in the management of poisonings. Further, the evidence supporting gastric lavage as a beneficial treatment in special situations is weak, as is the evidence to exclude benefit in all cases. Gastric lavage should not be performed routinely, if at all, for the treatment of poisoned patients. In the rare instances in which gastric lavage is indicated, it should only be performed by individuals with proper training and expertise.
This is somewhat muddled, and the insertion of the word “routinely” is somewhat disingenuous — no one has argued that gastric lavage should be a routine procedure in toxicology cases, at least not in the last 3 decades. But if we take this conclusion as stated, lavage will — thankfully — disappear. Since lavage may be justified only in “rare instances”, even if it is considered there will be no one around with enough experience in the procedure to have developed “expertise”. Best to bite the bullet and say don’t do it, period.