The client with bleeding esophageal varices has a Blakemore tube in place

Background

Balloon tamponade of bleeding esophageal varices was described as early as the 1930s. A double-balloon tamponade system was developed by Sengstaken and Blakemore in 1950 and has undergone relatively few changes up to the current day. [1, 2, 3, 4]  The three major components of a Sengstaken-Blakemore tube are as follows [see the image below]:

• Gastric balloon

• Esophageal balloon

• Gastric suction port

The addition of an esophageal suction port to help prevent aspiration of esophageal contents resulted in what is called the Minnesota tube. Another nasogastric [NG] device with a single gastric balloon is most effective at terminating bleeding from gastric varices and is known as the Linton-Nachlas tube [see the image below]. [5]

The advent of endoscopy has reduced the use of balloon tamponade, but the use of such devices can still be temporizing or lifesaving, despite their potential for serious complications. [6, 7, 8, 9, 10]

Indications

Indications for placement of a Sengstaken-Blakemore tube include the following:

• Acute life-threatening bleeding from esophageal or gastric varices that does not respond to medical therapy [including endoscopic hemostasis and vasoconstrictor therapy] [11, 12, 13, 14, 15]

• Acute life-threatening bleeding from esophageal or gastric varices when endoscopic hemostasis and vasoconstrictor therapy are unavailable

Chen et al described a case in which a Sengstaken-Blakemore tube was successfully used for nonvariceal distal esophageal bleeding [from severe ulcerative esophagitis] after conventional medical and endoscopic therapy had failed. [16]

Use of a Sengstaken-Blakemore tube to tamponade oropharyngeal hemorrhage during exploration of a carotid injury was reported by Bensley et al. [17]

Evans et al described a case where placement of a Sengstaken-Blakemore tube was employed as a rescue treatment for hemorrhagic shock secondary to laparoscopic adjustable gastric band erosion. [18]

A case series by Kim et al illustrated the use of s Sengstaken-Blakemore tube as a hemostatic tool in patients with life-threatening intractable oronasal bleeding secondary to facial trauma. [19]

Contraindications

Contraindications for placement of a Sengstaken-Blakemore tube include the following:

• Variceal bleeding stops or slows

• Recent surgery that involved the esophagogastric junction [EGJ]

Outcomes

In a study aimed at determining the effect of controlling variceal hemorrhage with a balloon tamponade device [eg, Minnesota or Sengstaken-Blakemore tube] on patient outcomes, Nadler et al assessed survival to discharge, survival to 1 year, and development of complications. [20] Approximately 59% of patients survived to discharge, and 41% were alive after 1 year. One complication, esophageal perforation, was noted; it was managed conservatively.

1. Bauer JJ, Kreel I, Kark AE. The use of the Sengstaken-Blakemore tube for immediate control of bleeding esophageal varices. Ann Surg. 1974 Mar. 179 [3]:273-7. [QxMD MEDLINE Link].

2. Boyce HW Jr. Modification of the Sengstaken-Blakemore balloon tube. N Engl J Med. 1962 Jul 26. 267:195-6. [QxMD MEDLINE Link].

3. SENGSTAKEN RW, BLAKEMORE AH. Balloon tamponage for the control of hemorrhage from esophageal varices. Ann Surg. 1950 May. 131 [5]:781-9. [QxMD MEDLINE Link].

4. Powell M, Journey JD. Sengstaken-Blakemore Tube. Treasure Island, FL: StatPearls; 2021. [Full Text].

5. Chojkier M, Conn HO. Esophageal tamponade in the treatment of bleeding varices. A decadel progress report. Dig Dis Sci. 1980 Apr. 25 [4]:267-72. [QxMD MEDLINE Link].

6. Conn HO, Simpson JA. Excessive mortality associated with balloon tamponade of bleeding varices. A critical reappraisal. JAMA. 1967 Nov 13. 202 [7]:587-91. [QxMD MEDLINE Link].

7. Paquet KJ, Feussner H. Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: a prospective controlled randomized trial. Hepatology. 1985 Jul-Aug. 5 [4]:580-3. [QxMD MEDLINE Link].

8. Yoshida H, Mamada Y, Taniai N, Tajiri T. New methods for the management of gastric varices. World J Gastroenterol. 2006 Oct 7. 12 [37]:5926-31. [QxMD MEDLINE Link].

9. Yan BM, Lee SS. Emergency management of bleeding esophageal varices: drugs, bands or sleep?. Can J Gastroenterol. 2006 Mar. 20 [3]:165-70. [QxMD MEDLINE Link].

10. [Guideline] Esophageal varices. World Gastroenterology Organisation [WGO]. Available at //www.worldgastroenterology.org/guidelines/global-guidelines/esophageal-varices/esophageal-varices-english. January 2014; Accessed: July 20, 2022.

11. Hunt PS, Korman MG, Hansky J, Parkin WG. An 8-year prospective experience with balloon tamponade in emergency control of bleeding esophageal varices. Dig Dis Sci. 1982 May. 27 [5]:413-6. [QxMD MEDLINE Link].

12. Panés J, Terés J, Bosch J, Rodés J. Efficacy of balloon tamponade in treatment of bleeding gastric and esophageal varices. Results in 151 consecutive episodes. Dig Dis Sci. 1988 Apr. 33 [4]:454-9. [QxMD MEDLINE Link].

13. D'Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology. 1995 Jul. 22 [1]:332-54. [QxMD MEDLINE Link].

14. Choi JY, Jo YW, Lee SS, Kim WS, Oh HW, Kim CY, et al. Outcomes of patients treated with Sengstaken-Blakemore tube for uncontrolled variceal hemorrhage. Korean J Intern Med. 2018 Jul. 33 [4]:696-704. [QxMD MEDLINE Link]. [Full Text].

15. Zuckerman MJ, Elhanafi S, Mendoza Ladd A. Endoscopic Treatment of Esophageal Varices. Clin Liver Dis. 2022 Feb. 26 [1]:21-37. [QxMD MEDLINE Link].

16. Chen YI, Dorreen AP, Warshawsky PJ, Wyse JM. Sengstaken-Blakemore tube for non-variceal distal esophageal bleeding refractory to endoscopic treatment: a case report & review of the literature. Gastroenterol Rep [Oxf]. 2014 Nov. 2 [4]:313-5. [QxMD MEDLINE Link]. [Full Text].

17. Bensley RP, Mohr AM, Huber TS, Sappenfield JW. Novel use of a Sengstaken-Blakemore tube during a neck exploration of a carotid injury: A case report. Injury. 2016 Sep. 47 [9]:2048-50. [QxMD MEDLINE Link].

18. Evans G, Eagon JC, Kushnir V. Sengstaken-Blakemore Tube as a Rescue Treatment for Hemorrhagic Shock Secondary to Laparoscopic Adjustable Gastric Banding Erosion. ACG Case Rep J. 2019 Dec. 6 [12]:e00296. [QxMD MEDLINE Link]. [Full Text].

19. Kim GW, Choi S, Han S, Lee Y, Kang B, Jung YS. Management of intractable oronasal bleeding using Sengstaken-Blakemore tubes in patients with facial trauma: a case series and technical notes. Clin Exp Emerg Med. 2021 Mar. 8 [1]:65-70. [QxMD MEDLINE Link]. [Full Text].

20. Nadler J, Stankovic N, Uber A, Holmberg MJ, Sanchez LD, Wolfe RE, et al. Outcomes in variceal hemorrhage following the use of a balloon tamponade device. Am J Emerg Med. 2017 Oct. 35 [10]:1500-1502. [QxMD MEDLINE Link]. [Full Text].

21. Edlich RF, Landé AJ, Goodale RL, Wangensteen OH. Prevention of aspiration pneumonia by continuous esophageal aspiration during esophagogastric tamponade and gastric cooling. Surgery. 1968 Aug. 64 [2]:405-8. [QxMD MEDLINE Link].

22. Collyer TC, Dawson SE, Earl D. Acute upper airway obstruction due to displacement of a Sengstaken-Blakemore tube. Eur J Anaesthesiol. 2008 Apr. 25 [4]:341-2. [QxMD MEDLINE Link].

23. Agarwal R, Aggarwal AN, Gupta D. Endobronchial malposition of Sengstaken-Blakemore tube. J Emerg Med. 2008 Jan. 34 [1]:93-4. [QxMD MEDLINE Link].

24. Pinto-Marques P, Romãozinho JM, Ferreira M, Amaro P, Freitas D. Esophageal perforation--associated risk with balloon tamponade after endoscopic therapy. Myth or reality?. Hepatogastroenterology. 2006 Jul-Aug. 53 [70]:536-9. [QxMD MEDLINE Link].

25. Tan CY, Yang SM, Ko HJ. Successful Management of Sengstaken-Blakemore Tube-Induced Esophageal Perforation Using Metallic Covered Stent for a Patient with a History of Variceal Bleeding. Am Surg. 2019 Mar 1. 85 [3]:e179-e181. [QxMD MEDLINE Link].

26. Rosat A, Martín E. Tracheal rupture after misplacement of Sengstaken-Blakemore tube. Pan Afr Med J. 2016. 23:55. [QxMD MEDLINE Link]. [Full Text].

27. Kim SM, Ju RK, Lee JH, Jun YJ, Kim YJ. Unusual cause of a facial pressure ulcer: the helmet securing the Sengstaken-Blakemore tube. J Wound Care. 2015 Jun. 24 [6 Suppl]:S14-6. [QxMD MEDLINE Link].

Author

Richard Treger, MD Assistant Clinical Professor of Medicine, Division of Nephrology, Greater Los Angeles VA Healthcare System, University of California, Los Angeles, David Geffen School of Medicine

Disclosure: Nothing to disclose.

Coauthor[s]

Thomas P Graham, MD, FACEP Clinical Professor of Medicine, Emergency Medicine, University of California at Los Angeles School of Medicine, UCLA Medical Center

Thomas P Graham, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Wilderness Medical Society

Disclosure: Nothing to disclose.

Stanley K Dea, MD Chief of Endoscopy, Acting Chief of Gastroenterology, Consulting Gastroenterologist Olive View-University of California at Los Angeles Medical Center; Director of Enteral Feeding, West Los Angeles Veterans Affairs Medical Center; Director of Endoscopic Training, University of California at Los Angeles Affiliated Training Program in Gastroenterology

Stanley K Dea, MD is a member of the following medical societies: American Society for Gastrointestinal Endoscopy, Southern California Society of Gastroenterology

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Vikram Kate, MBBS, PhD, MS, FACS, FACG, FRCS, FRCS[Edin], FRCS[Glasg], FIMSA, FFST[Ed], MAMS, MASCRS Professor of General and Gastrointestinal Surgery and Senior Consultant Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research [JIPMER], India

Vikram Kate, MBBS, PhD, MS, FACS, FACG, FRCS, FRCS[Edin], FRCS[Glasg], FIMSA, FFST[Ed], MAMS, MASCRS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society of Colon and Rectal Surgeons, Fellow of the Faculty of Surgical Trainers [RCSEd], Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

Acknowledgements

Thanks to CR Bard, Inc, for their assistance.

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the assistance of Lars J Grimm, MD, MHS, with the literature review and referencing for this article.

The Chief Editor would like to acknowledge the assistance of Dr Mohsina Subair, Postgraduate Resident, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research [JIPMER], Pondicherry, India, in updating the review of this article.

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