Sengstaken-Blakemore Tube Placement

Updated: Sep 06, 2016
  • Author: Richard Treger, MD; Chief Editor: Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS  more...
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Overview

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]  The three major components of a Sengstaken-Blakemore tube are as follows (see the image below):

  • Gastric balloon
  • Esophageal balloon
  • Gastric suction port
Sengstaken-Blakemore tube. Image courtesy of Richa Sengstaken-Blakemore tube. Image courtesy of Richard Treger, MD.

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). [4]

Linton-Nachlas tube. Image courtesy of Richard Tre Linton-Nachlas tube. Image courtesy of Richard Treger, MD.

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. [5, 6, 7, 8, 9]

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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) [10, 11, 12]
  • 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. [13]

A novel use of a Sengstaken-Blakemore tube to tamponade oropharyngeal hemorrhage during exploration of a carotid injury was reported by Bensley et al. [14]

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Contraindications

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

  • Variceal bleeding stops or slows
  • Recent surgery that involved the esophagogastric junction
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