Sengstaken-Blakemore tube

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A Sengstaken-Blakemore tube is an oro- or nasogastric tube used occasionally in the management of upper gastrointestinal hemorrhage due to bleeding from esophageal varices (distended veins in the esophageal wall, usually as a result of cirrhosis). It was originally described in 1950.^[1] The use of esophageal tamponade in the treatment of bleeding varices has been known since Westphal described it in 1930.^[2]

It consists of a multiluminal plastic tube with two inflatable balloons. Apart from the balloons, two lumens serve the proximal esophagus and the gastric tip of the device, respectively (although earlier devices had no oesophageal lumen, requiring the parallel insertion of a nasogastric tube^[3]). It is passed down into the oesopagus and the distal balloon inflated in the stomach. Distension of the proximal balloon is used to stop bleeding from the varices. The gastric lumen is for aspirating stomach contents.

Generally it is used only in emergencies where bleeding from presumed varices is impossible to control by administration of medication. It may be difficult to position, particularly in an unwell patient, and may inadvertently be inserted in the trachea, hence endotracheal intubation before the procedure is strongly advised to secure the airway. The tube is often kept in the refrigerator in the hospital's emergency department, intensive care unit and gastroenterology ward. It is a temporary measure: ulceration and rupture of the esophagus and stomach are recognized complications.^[3][4]

A related device with a larger gastric balloon capacity, the Linton-Nachlas tube, is used for isolated gastric hemorrhage (such as with gastric varices).

References

1. ^ Sengstaken RW, Blakemore AH. Balloon tamponage for the control of hemorrhage from esophageal varices. Ann Surg 1950;131:781-9. PMID 15411151.
2. ^ Westphal K. Ueber eine Kompressionsbehandlung der Blutungen aus Oesophagusvarizen. Deutsch Med Wochenschr 1930;56:1135.
3. ^ ^{a b} Bauer JJ, Kreel I, Kark AE. The use of the Sengstaken-Blakemore tube for immediate control of bleeding esophageal varices. Ann Surg 1974;179:273-7. PMID 4544329.
4. ^ Chien JY, Yu CJ (2005). "Images in clinical medicine. Malposition of a Sengstaken-Blakemore tube". N. Engl. J. Med. 352 (8): e7. doi:10.1056/NEJMicm040003. PMID 15728803.