Gastric Decontamination in Asia: Beyond the Position Statements
Rick, FL Lau1
1Chairman , clinical toxicology board, Hong Kong College of Emergency Medicine, Hong Kong
There are wide variations of clinical practice of gastric decontamination of ingested poisoning in different parts of the world. To help to standardize the treatment, position statements were prepared by American Academy of Clinical Toxicology (NACCT) and European Association of Poisons Centres and Clinical Toxicologists ( EAPCCT).
The position statements advocate use of activated charcoal for most recent poisoning and replacing gastric lavage in most situations. And conclude that there is no evidence to support gastric lavage should be used routinely in the management of poisonings.
However, gastric lavage is still the standard practice in many developing Asian countries. A survey of 8 Asia-pacific countries found that many developing countries still use gastric lavage to treatment a large number of poisoned patients. While the evidence to support gastric lavage for mild to moderate poisoning is slim. With some 3% risk of major complication, it is reasonable to be replaced it with activated charcoal in these situations. However, no evidence to support usefulness does not mean there is definite evidence to support no benefit; it may only mean the study is not powerful enough. In fact the literature search for formulating the position statements are mainly in the English language and most of the studies did not include enough life-threatening poisonings.
Furthermore, the external validity of study conducted in the developed countries cannot be extrapolated to developing countries where there is neither availability of common antidotes nor enough ICU facility for supportive care. A survey of 8 Asia-pacific countries suggests the lack of ICU support and inadequate antidote cover correlate with more common use of gastric lavage.