Acute variceal bleeding is a life-threatening event. Endoscopic band ligation is currently the recommended treatment [1]; however, in the case of reduced variceal volume, injection therapy with polidocanol or Histoacryl may be more appropriate. If both endoscopic options fail, placement of a Sengstaken–Blakemore tube should be considered [2], although other endoscopic therapies can be used [3]. A 54-year-old man with a known history of compensated alcoholic cirrhosis presented in the emergency roomwith acute hematemesis. The vital signs were stable and laboratory workup showed mild anemia and thrombocytopenia. Upper endoscopy revealed a peptic esophagitis with confluent ulceration and a spurting variceal hemorrhage in the cardia. After injection of 10ml of 1% polidocanol, that did not control the bleeding, a Sengstaken– Blakemore tube (Cliny type 42; Create Medic Co, Yokohama, Japan) was positioned, with 250ml of air insufflated in the gastric balloon and 80ml in the esophageal balloon. For traction maintenance, a 500-ml bag of saline was used, as was regular practice. However, after 10 minutes part of the tube suddenly became exteriorized (● Fig.1). As the video demonstrates (● Video1) the extremity with the deflated balloon, because of spontaneous transection 3cm proximally to the balloon insertion, was still in place. It was decided to remove the tube with a snare. On revision there was no active bleeding, hence no treatment was carried out. The use of a Sengstaken–Blakemore tube is increasingly rare, mostly because of the high incidence of complications, such as aspiration pneumonia, airway obstruction, pressure necrosis of the mucosa, esophageal rupture, and cardiac inflow obstruction [4–6]. To our knowledge this is the first video showing the extraction of a Sengstaken–Blakemore tube that had transected probably because of a manufacturing defect. To prevent this situation a careful assessment of the tube must be made before placement. Besides the very successful resolution using a standard endoscopic extraction procedure, we emphasize the rarity of the video images of this unusual situation.