Gastroesophageal varices are among the most dangerous complications associated with cirrhosis. They are present in 50% to 60% of cirrhotic patients.1 Approximately 30% of patients will experience an episode of variceal hemorrhage within 2 years of the diagnosis of varices.1 The major factors that determine the risk of bleeding are variceal size and the degree of liver dysfunction.1-3 Variceal bleeding stops spontaneously in 20% to 30% of cases.1-4 It recurs in 70% of patients within 1 year of the initial episode.1-4 Mortality is as high as 50% in the first year.5 Variceal bleeding accounts for almost one-third of deaths in cirrhotic patients. Variceal hemorrhage has a poor prognosis if it is associated with coexisting or subsequent complications (e.g., rebleeding, infection, hepatic dysfunction, and portal pressure ≥ 12 mmHg).6,7 Somatostatin and its analogues cause splanchnic vasoconstriction, leading to reduced portal pressure and portal blood flow, whereas venodilators reduce portal pressure by reducing resistance to portal flow.7,8
Doctors Sengstaken and Blakemore developed the concept of balloon tamponade to control bleeding esophageal and gastric varices in 1950. They developed a triple-lumen and double-balloon system that bears their names. The Sengstaken-Blakemore (SB) tube is used as a temporizing measure to stop variceal bleeding until more definitive means are available (Figures 81-1 and 81-2). The SB tube was designed for the control of esophageal varices and as a diagnostic aid to determine the source of hemorrhage into the stomach. There are variants of the SB tube (e.g., the Minnesota tube and the Linton-Nachlas tube). The Minnesota tube is a quadruple-lumen, double-balloon system (Figure 81-3).9 The Linton-Nachlas tube was designed with only an esophageal balloon (Figure 81-4). It controls bleeding for esophageal varices. These tubes are rarely used today due to the significant complications and the widespread availability of endoscopy and its therapeutic interventions.
Schematic illustration of the Sengstaken-Blakemore tube.
The Sengstaken-Blakemore tube. A. Overall view of the SB tube. B. The proximal ports. C. The esophageal and gastric balloons in the inflated and deflated states. D. The distal end.
The Minnesota tube. A. Photo. Gastric balloon (A), esophageal balloon (B), gastric and esophageal suction ports (C), gastric balloon control branch point (D), gastric balloon control port with Christmas tree connector and three-way stopcock (E and F), repeat of gastric balloon set-up on the esophageal balloon side (G). (Used with permission from reference 9.) B. Schematic illustration.