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):
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Gastric balloon
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Esophageal balloon
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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:
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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:
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Variceal bleeding stops or slows
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Recent surgery that involved the esophagogastric junction (EGJ)
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Known esophageal stricture
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.
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Sengstaken-Blakemore tube. Image courtesy of Richard Treger, MD.
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Linton-Nachlas tube. Image courtesy of Richard Treger, MD.
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Lopez valve. Image courtesy of Richard Treger, MD.
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Pulley device for traction. Image courtesy of Richard Treger, MD and Stanley Dea, MD.
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Sphygmomanometer. Image courtesy of Richard Treger, MD.
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Vacuum suction device. Image courtesy of Richard Treger, MD.
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Setup for measuring gastric or esophageal balloon pressure. Image courtesy of Richard Treger, MD.
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NG tube tied along Sengstaken-Blakemore tube. Image courtesy of Richard Treger, MD.
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Air being suctioned from gastric balloon using 60-mL syringe. Image courtesy of Richard Treger, MD.
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Plastic plug being inserted into lumen of balloon port. Image courtesy of Richard Treger, MD.
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Illustration of placement of Sengstaken-Blakemore tube. Image courtesy of CR Bard, Inc.
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Illustration of setup for inflating and measuring pressure in esophageal balloon. Image courtesy of CR Bard, Inc.
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Y-tube connector. Image courtesy of Richard Treger, MD.
