The phrase “stomach pumping,” often featured in older media, refers to Gastric Lavage (GL), a medical procedure for gastrointestinal decontamination. For decades, GL was a widely accepted method for removing toxic substances from the stomach before absorption. Modern medical practice has largely abandoned its routine use, due to growing evidence concerning its limited effectiveness and the significant risks it poses to the patient.
Understanding Gastric Lavage
Gastric Lavage is a procedure designed to wash out the stomach contents following the ingestion of a toxic substance. The technique involves inserting a large-bore orogastric tube (36 to 40 French in adults) down the esophagus and into the stomach. The tube’s large diameter is necessary to retrieve pill fragments and solid materials.
Once the tube is positioned, small volumes of fluid, usually warm water or saline, are instilled into the stomach. This fluid is then immediately drained or aspirated out, along with any loosened stomach contents, in a repetitive sequence. This process continues until the fluid returning from the stomach is clear, indicating that the bulk of the contents has been removed.
Reasons for Clinical Decline
The primary reason for the clinical decline of gastric lavage is the lack of evidence demonstrating improved patient outcomes, such as decreased mortality. Studies show the procedure is only reliably effective if performed very soon after ingestion. For instance, substance recovery drops dramatically from about 90% at five minutes to as little as 8% by 60 minutes post-ingestion.
Most patients arrive after this narrow window has passed, making the procedure largely ineffective. Even when performed promptly, the amount of toxin removed is highly variable and often negligible. This poor efficacy, combined with the procedure’s inherent dangers, led medical toxicologists to reconsider its role.
The procedure carries several serious risks that can worsen a patient’s condition. The most feared complication is aspiration pneumonitis, which occurs when stomach contents are inhaled into the lungs. The risk of aspiration is especially high if the patient has a decreased level of consciousness and an unprotected airway, a common scenario in overdose cases.
The forceful insertion of the large tube also creates a risk of mechanical injury to the gastrointestinal tract. This can result in rare but life-threatening complications like esophageal or gastric perforation. The procedure can also cause fluid and electrolyte imbalances, especially in children, and may distract medical staff from initiating more effective supportive care.
Modern Alternatives for Decontamination
The modern standard of care for acute poisoning has shifted away from forceful stomach emptying toward less invasive and more targeted treatments. Activated charcoal (AC) is now the principal method of gastrointestinal decontamination for many types of ingestions. This substance works by a process called adsorption, where the vast surface area of the charcoal binds to the toxin molecules in the stomach and intestines.
Once the toxins are bound to the charcoal, they cannot be absorbed into the bloodstream and are instead safely passed out of the body. Activated charcoal is preferred because it is non-invasive and highly effective for a wide range of substances, provided it is given relatively soon after ingestion. However, it does not bind to all toxins, such as alcohols, hydrocarbons, and heavy metals.
For many poisonings, the focus is placed on supportive care rather than attempting to physically remove the toxin. This involves stabilizing the patient’s breathing, blood pressure, and heart rhythm while the body naturally metabolizes and eliminates the poison. This approach recognizes that for most ingestions, maintaining organ function is the most effective way to improve patient survival.
Whole Bowel Irrigation (WBI) is another technique used for specific, niche scenarios where activated charcoal is ineffective. WBI involves administering large volumes of a polyethylene glycol solution to flush the entire gastrointestinal tract. This method is typically reserved for substances not bound by charcoal, such as iron or lithium, or for sustained-release medications that may continue to release toxins over many hours.