Whole-Bowel Irrigation

Updated : August 21, 2025

Among the various methods used to prevent overdoses, whole-bowel irrigation (WBI) is a technique used to prevent the absorption of ingested substances by inducing a liquid stool with a polyethylene glycol electrolyte solution (PEG-ES). The researchers have already demonstrated the ability of a WBI patient to reduce the peak serum lithium concentrations within 12 hours of an overdose, to keep the ICU admissions at minimum, and the Poisoning Severity Score dropped off by some points. Treatments such as hemodialysis can be avoided in case of sustained-release lithium or potassium chloride overdose if WBI is taken at an early stage. On the other hand, WBI can be safely administered to the younger patients with few cases of side effects being reported.

While WBI is not recommended routinely as a method of GI decontamination for poisoned patients, some situations need to be taken into consideration.

This procedure is considered in the following:

Before operation, colonoscopy, or a barium enema to clear the bowel
Accidental intake of a life-threatening dose of drugs such as a sustained-release form of medication like potassium chloride which may harm the heart slowly because of its low absorption rate could induce severe or even fatal toxic poisoning in patients.
Induction of a pernicious or life-threatening measure of medicines or xenobiotics which are not adsorbed by AC (activated charcoal) in the stomach of a patient, as well as a condition when there is no other way of removing the drugs from the digestive tract than using the GI decontamination methods (eg, iron supplements, lead foreign body, or lithium.
Drug carrying by water beads with no symptoms of blockage.
Hypertrophic pyloric stenosis with pharmacobezoar formation identified on abdominal

These include:

Compromised or unprotected airway

Intractable vomiting

Ileus, perforation, or bowel obstruction

Unstable vital signs

Significant gastrointestinal bleeding

Signs of hyperthermia, tachycardia, hypotension

Factors that affect the outcome of whole-bowel irrigation includes the time of initiation, the type and toxicity of ingested substance, effectiveness of removal of toxin, general health consitio of patient and concurrent medical interventions. If initiated early, the prognosis can be more favourable. Other factors which would decide this are the nature and concentration of the substance. Variables associated with with the efficacy of removal of toxin include factors like the adequacy of bowel preparation, type of cathartic used, and total volume administered.

Following materials are required for WBI:

10% lidocaine solution
2% KY jelly or lidocaine jelly for lubrication
Reservoir bag for holding irrigation PEG-ES
Nasogastric tube or required size
Intravenous pole for hanging irrigation solution bag

Anesthesia

The combined use of lidocaine spray and lubricating jelly into catheter injection through the nose was found to be efficient and less painful compared to the use of lubricating jelly alone. The combination also reduced any pain, distress or injury from occurring to the patient while at the same time improving the satisfaction of the physicians and nurses during the process. Most importantly, it was advised that the medicated lube should be adopted.

A plain abdominal film should be done to verify NG tube placement before commencement of the irrigating solution. The patient must be in a comfortable sitting position on a bedside commode.

The nasogastric tube is inserted with the help of PEG-ES (polyethylene glycol electrolyte solution) used for children so that the liquid substance should be given through the nasogastric tube or larynx. Do not apply it with force if it sticks during the process of inserting inside. A patient toilet should be put by his bed and the patient be sitting comfortably. The whole process generally takes 4-6 hours. Patients usually feel sick, so it can occur that they are sick in this case, and in this scenario, it may be necessary to slow the infusion rate. Alternatively, can be an antiemetic given. The method should be terminated, when there is a colourless rectal effluent or if all drug packets have been expelled.

The study that compared two groups, one of which received 10 mg of oral metoclopramide 30 minutes before WBI and the other took a placebo, showed that whole-bowel irrigation (WBI) was not found to be more effective when the subjects were given antiemetic drugs before the procedure.

Mallory-Weiss tear

Esophageal perforation

Urticaria

Severe immediate hypersensitivity

Organ injuries during the insertion of NG tube

Angiodema of lips

Abdominal bloating

Abdominal cramps

ARDS (acute respiratory distress syndrome)

Nausea

Vomiting

Death