Sengstaken-Blakemore Tube Placement

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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):

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]

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]}

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

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. ^[14]

A novel use of a Sengstaken-Blakemore tube to tamponade oropharyngeal hemorrhage during exploration of a carotid injury was reported by Bensley et al. ^[15]

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

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.22 Approximately 59% of patients survived to discharge, and 41% were alive after 1 year. One complication, esophageal perforation, was noted; it was managed conservatively.

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. [Medline].

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

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

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. [Medline].

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

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. [Medline].

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. [Medline].

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

[Guideline] Esophageal varices. World Gastroenterology Organisation (WGO). Available at http://www.worldgastroenterology.org/guidelines/global-guidelines/esophageal-varices/esophageal-varices-english. January 2014; Accessed: October 30, 2018.

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. [Medline].

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. [Medline].

D’Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology. 1995 Jul. 22 (1):332-54. [Medline].

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. [Medline]. [Full Text].

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. [Medline]. [Full Text].

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. [Medline].

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. [Medline].

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. [Medline].

Agarwal R, Aggarwal AN, Gupta D. Endobronchial malposition of Sengstaken-Blakemore tube. J Emerg Med. 2008 Jan. 34 (1):93-4. [Medline].

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. [Medline].

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

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. [Medline].

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. [Medline]. [Full Text].

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.

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.

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.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, 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, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, 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, Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

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.

Sengstaken-Blakemore Tube Placement

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