Sengstaken-Blakemore Research Articles

Innovative Technique for Endoscopic Placement of Sengstaken-Blakemore Tube.

The Sengstaken-Blakemore (SB) tube is used in cases of uncontrolled variceal bleeding. Because of the complexity of the procedure and the lack of visualization, various techniques have been described to avoid blind placement. We report an innovative and simple technique for placement of the SB tube under direct endoscopic visualization. A grasp-and-place technique for endoscopic placement of SB tubes is described and a retrospective cohort study chart review of endoscopies done for variceal bleeding in our medical center is reported. All patients with uncontrolled variceal bleeding who required placement of an SB tube from July 1, 2013 through December 31, 2015 were included. The primary outcome analyses were technical success of tube placement and achievement of hemostasis. Of 143 endoscopies done for variceal bleeding, 10 were managed with SB tubes placed endoscopically after initial endoscopic therapy was unsuccessful. Successful placement of the tube was achieved in all of the patients. Hemostasis was achieved in 9 of the 10 patients. We propose a new grasp-and-place technique for endoscopic placement of SB tubes. Review of our experience shows that massive variceal bleeding can be managed effectively with this technique.

Risk Factors and On-site Rescue Treatments for Endoscopic Variceal Ligation Failure.

The success rate of endoscopic variceal ligation (EVL) is about 85-94%. There is only a few studies attempting to determine the cause of EVL failure, and to date, on-site rescue treatments remains unestablished. This study aimed to elucidate the risk factors for EVL failure and the effectiveness of on-site rescue treatment. Data of 454 patients who underwent emergency EVL at Chonnam National University Hospital were retrospectively analyzed. Enrolled patients were divided into two groups: the EVL success and EVL failure groups. EVL failures were defined as inability to ligate the varices due to poor endoscopic visual field, or failure of hemostasis after band ligation for the culprit lesion. Forty-seven patients experienced EVL failure. In the multivariate analysis, male patients, initial hypovolemic shock, active bleeding on endoscopy, and history of previous EVL were independent risk factors for EVL failure. During endoscopic procedure, we came across the common causes of EVL failure, including unsuctioned varix due to previous EVL-induced scars followed by insufficient ligation of the stigmata and inability to ligate the varix due to poor endoscopic visual field. Endoscopic variceal obturation using N-butyl-2-cyanoacrylate (48.9%) was the most commonly used on-site rescue treatment method, followed by insertion of Sangstaken Blakemore tube (14.9%), and EVL retrial (12.8%). The rescue treatments successfully achieved hemostasis in 91.7% of those in the EVL failure group. The risk factors of EVL failure should be considered before performing EVL, and in case of such scenario, on-site rescue treatment is needed.

Magnetic resonance imaging analysis of brain function in patients with irritable bowel syndrome

BackgroundIrritable bowel syndrome (IBS) is a common functional disease of the gastrointestinal tract. The current study aimed to examine the association between visceral hypersensitivity in IBS and cortical activation using functional magnetic resonance imaging (fMRI), and to elucidate the role of psychological factors in the pathogenesis of IBS.MethodsThe present study included 31 patients with IBS and 20 healthy controls. Cerebral function was assessed using fMRI. During imaging, a Sengstaken-Blakemore tube was placed within the rectum approximately 10 cm from the anus, following which gas was rapidly injected into the airbag using a 150-ml syringe. Images were obtained at 40 ml, 80 ml, and 120 ml of expansion. Psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS).ResultsAnxiety and depression scores were higher among patients with IBSthan among controls (both P < 0.05), although scores in both groups were below the level of clinical diagnosis. Brain activation in regions of interest (parietal areas, prefrontal cortex, cerebellum, anterior cingulate cortex, insular cortex, and thalamus) increased along with increases in rectal balloon dilation, except in women with IBS and patients with disease duration less than 5 years. Furthermore, region of interest (ROI) activation (such as the parietal region, prefrontal cortex, cerebellum, anterior cingulate cortex, insular cortex, and thalamus) differed significantly between the 40-ml and 120-ml conditions, and between the 80-ml and 120-ml conditions (P < 0.05), among patients with IBS with anxiety or depression scores less than 9 points.ConclusionsOverall, our findings indicate that changes in brain activation due to changes in rectal balloon distension can be objectively and accurately measured using fMRI. Although our results indicated that visceral hypersensitivity during IBS is associated with changes in cortical activation, further studies utilizing larger sample sizes are required to more fully elucidate the association between psychological factors and visceral hypersensitivity in IBS.

Outcomes of patients treated with Sengstaken-Blakemore tube for uncontrolled variceal hemorrhage.

Background/AimsThe aim of this study was to investigate the mortality, bleeding control rate, and their associated predictors in patients treated with Sengstaken-Blakemore (SB) tube for uncontrolled variceal hemorrhage associated with hemodynamic instability or failure of endoscopic treatment.MethodsThe clinical data of 66 consecutive patients with uncontrolled variceal hemorrhage treated with SB tube at Gyeongsang National University Hospital from October 2010 to October 2015 were retrospectively analyzed.ResultsThe overall success rate of initial hemostasis with SB tube was 75.8%, and the independent factors associated with hemostasis were non-intubated state before SB tube (odds ratio, 8.50; p = 0.007) and Child-Pugh score < 11 (odds ratio, 15.65; p = 0.022). Rebleeding rate after successful initial hemostasis with SB tube was 22.0%, and esophageal rupture occurred in 6.1%. Mortality within 30 days was 42.4%, and the related independent factors with mortality were failure of initial hemostasis with SB tube (hazard ratio, 6.24; p < 0.001) and endotracheal intubation before SB tube (hazard ratio, 2.81; p = 0.018).ConclusionsSince the era of endoscopic band ligation, SB tube might be a beneficial option as a temporary salvage treatment for uncontrolled variceal hemorrhage. However, rescue therapy had a high incidence of fatal complication and rebleeding.

Esophageal submucosal hematoma developed after endovascular surgery for unruptured cerebral aneurysm under general anesthesia: a case report

BackgroundEsophageal submucosal hematoma is a rare complication after endovascular surgery. We report a case of an esophageal submucosal hematoma which may have been caused by rigorous cough during extubation.Case presentationA 75-year-old woman underwent endovascular treatment for unruptured cerebral aneurysm under general anesthesia. The patient received aspirin and clopidogrel before surgery and heparin during surgery. Activated clotting time was 316 s at the end of surgery. Protamine was not administered and continuous infusion of argatroban was started after surgery. She had a rigorous cough during removal of the tracheal tube and reported retrosternal discomfort postoperatively. She developed hemorrhagic shock after massive hematemesis. A diagnosis of esophageal submucosal hematoma was made by endoscopic examination and computed tomography. Hemostasis was achieved by compression with a Sengstaken-Blakemore tube and endoscopic cauterization. Blood pressure was recovered by blood transfusion. Endoscopic examination performed 7 days after surgery showed that esophageal submucosal hematoma had almost disappeared and slough had adhered to the mucosal laceration. The patient showed good recovery and was discharged 21 days after surgery.ConclusionsCareful extubation and postoperative observation are required in patients receiving antiplatelet and anticoagulant therapy.

Endoscopic Placement of Sengstaken-Blakemore Tube for Bleeding Esophageal Varices

Placement of a Sengstaken-Blakemore tube can oftentimes prove technically difficult in the emergent setting. Ascertaining correct position prior to insufflation of the gastric balloon is imperative, and oftentimes leads to significant treatment delay while awaiting xray confirmation. We present a case demonstrating a novel technique of endoscopic placement. A fifty-five year old male with a history of decompensated alcohol cirrhosis and hepatorenal syndrome developed hematemesis and hemorrhagic shock. Emergent endoscopy was performed and due to anatomical limitations, sclerotherapy of bleeding esophageal varices was performed with moderate success. Due to continued bleeding and high risk of rebleeding, a Sengstaken-Blakemore tube was placed under direct visualization with the use of a snare and gastroscope. The snare was used to grasp the tip of the Sengstaken-Blakemore tube and pulled tight into the scope with the tube positioned directly along side of the scope. Next, the gastroscope was then carefully advanced through the oropharynx and upper esophagus with the snare grasping the tip of the Sengstaken-Blakemore tube and pulling it through into the stomach. The scope was advanced to the antrum of the stomach and retroflexed to ensure the gastric balloon was completely located in the stomach. Next, the gastric balloon was inflated with 250 ml of air under direct visualization. After the Sengstaken-Blakemore tube was secured, the snare was then opened and removed from the endoscope. While the balloon was inflated, the endoscope was then easily withdrawn without displacing the Blakemore tube. Bleeding was successfully controlled. Watch the video: https://goo.gl/wqwVTv

Congenital Absence of the Splenic Artery Presenting as Massive Gastric Hemorrhage

Gastric bleeding due to collateral arteries from a congenital absence of the splenic artery is very rare. To the best of our knowledge it has been reported only three other times in literature. Treatment of these difficult to visualize vessels can be challenging as the unknown vascular anatomy can lead to an unsure diagnosis and hesitant treatment during emergent endoscopy. We present a case of massive gastrointestinal bleeding from an aberrant artery in the fundus in the absence of the splenic artery treated with coli embolization and endoscopic ultrasound (EUS) guided placement of over the scope clip (OTSC). A 66-year-old male presented with hematemesis and hemorrhagic shock. Within the last eight years, the patient had undergone previous endoscopies for hematemesis and melena without evidence of active GI bleeding at time of endoscopy. However, the presence of thickened folds in the fundus, suggestive of isolated gastric varices, had been noted but no further investigations performed. Emergent upper endoscopy this time revealed a large clot within the fundus that was unable to be cleared. Blakemore tube was placed to while the patient was further stabilized. Computerized tomography (CT) showed no evidence of cirrhosis, portal hypertension or splenic vein thrombus though it did show an ongoing arterial bleed in the fundus around the gastric balloon of the Blakemore tube. Visceral angiogram found an absence of the splenic artery with collateral flow of short gastric vessels. The left and right gastric arteries were hypertrophied and there was active bleeding at the left gastric branch vessel at the fundal level. Coil embolization at the mid-distal left gastric artery resulted in successful hemostasis. Over the next few days the patient remained hemodynamically stable but had a down trending hemoglobin level. In hopes to localize and direct endoscopic intervention an upper endoscopy with EUS was performed. There was an area of tortuous and thicken folds with ulceration in the fundus with evidence of oozing and an OTSC was placed. The patient remained stable and was discharged three days later. This case describes a rare condition of a congenital absence of the splenic artery that lead to massive gastrointestinal hemorrhage from aberrant arterial vessels. Quick diagnosis and the use of both endoscopic and interventional radiologic treatments resulted in a successful outcome without the need for surgery.

Trainee Update, Winter 2017

The Specialist Advisory Committee (SAC) of June 2017 discussed the sign off of procedural competences relating to Sengstaken-Blakemore tube insertion and transvenous cardiac pacing and the application for chief registrar roles.

Transluminal Washout and Debridement as an Adjunct to Endoscopic Defect Repair

Gastrointestinal tract perforations have been traditionally managed by surgery and often result in significant morbidity and mortality. The surgical dictum that has been developed and proven over generations states that when a site has been contaminated, it must be washed-out, debrided, and drained, in addition to the defect being repaired. As endoscopic methods are increasingly used for luminal defect repairs, we must appreciate this long standing precedent. We describe the use of endoscopic wash-out and debridement in addition to luminal defect closure in two patients with iatrogenic perforations. Case 1: 50 year old male with a 12 cm esophageal perforation secondary to Minnesota tube placement. Closure was complicated by stent migration and two failed endosuturing attempts. Defect closure was finally completed with a fully covered stent that was secured in place with three sutures. During three of the attempted closures, the thoracic cavity was debrided with suction, Roth Net®, or snare followed by high volume lavage. On day 75, the stent was exchanged and a medium sized fistula was noted. Fulguration of the opening with argon plasma coagulation (APC) was performed. Follow up EGD on day 109 showed complete resolution of the perforation and ultimately the patient returned to a regular diet and full activities of daily living (ADL). Case 2: 48 year old male who underwent pancreatic neuroendocrine tumor resection that was complicated by a 1.5 cm gastric fundus perforation. The patient failed surgical repair and endoscopic closure was attempted. The peritoneal cavity was debrided of necropurulent material, copiously lavaged, and five endosutures were placed. The fistula was ablated with APC to allow for granulation tissue to form. Cross sectional imaging two weeks later showed persistent gastric leak for which repeat endoscopic debridement, peritoneal wash-out, repeat APC, and endosuturing was performed. Follow-up imaging one week later showed resolution of the perforation and ultimately the patient returned to a regular diet and full ADL. In conclusion, these patients represent complex perforations with gross contamination that were not felt to be amenable to surgical closure. The successful management of perforations using transluminal endoscopic exploration may offer a less invasive and less expensive means to managing these patients. Further studies are required before broad implementation can be recommended. Watch the video: https://goo.gl/s7bZNz

Endoscopic variceal ligation-induced ulcer bleeding: What are the risk factors and treatment strategies?

This study was aimed to determine the risk factors of endoscopic variceal ligation-(EVL) induced ulcer bleeding.The prevalence of EVL-induced ulcer bleeding is reported to be 3.6%. However, there are only limited reports of this serious complication, and the risk factors and the treatment methods are not well established.A total of 430 patients who had undergone EVL in Chonnam National University Hospital from January 2014 to October 2016 were studied. EVL was performed for prophylaxis or acute hemorrhage. The patients were classified into 2 groups: a bleeding group (n = 33) and a non-bleeding group (n = 397). The patients who had endoscopically confirmed EVL-induced ulcer bleeding were included in the bleeding group.EVL-induced ulcer bleeding occurred in 7.7% (n = 33) of the patients. In a multivariate analysis, model for end-stage liver disease (MELD) score >10 (odds ratio [OR]: 3.42, 95% confidence interval [CI]: 1.10–10.64), concomitant GV F3 (OR: 14.1, 95% CI: 2.84–71.43), and detachment of o-ring bands on follow-up endoscopy (OR: 8.06, 95% CI: 2.55–25.64) were independent predictive factors of EVL-induced ulcer bleeding. Various endoscopic modalities were attempted for hemostasis (EVL in 8 cases [24.2%], endoscopic variceal obturation [EVO] with cyanoacrylate in 6 cases [18.2%], argon plasma coagulation [APC] in 1 case (3%), Sengstaken–Blakemore (SB) tube in 3 cases [9.1%]), and proton pump inhibitor therapy only in 15 cases (45.5%).MELD score >10, concomitant GV F3, and detachment of o-ring bands on follow-up endoscopy are risk factors for EVL-induced ulcer bleeding.

Reply

Potential conflict of interest: Dr. Morillas advises for and is on the speakers' bureau for Gilead, AbbVie, Merck, and Bristol‐Myers Squibb. Dr. Escorsell received grants from Vital Therapies. Dr. Garcia‐Pagan received grants from Gore, Exalenz, and Novartis. Reply: We sincerely thank Gundling et al. for their letter. We totally agree with them that migration after deployment of self‐expanding esophageal covered metal stents (SX‐ELLA Danis) is not an uncommon complication of this device. In fact, some researchers reported an incidence of stent migration as high as 25%.1 However, migration by itself should not be considered as an adverse event or equivalent to treatment failure—unless it gives rise to a specific complication or rebleeding. Of course, in our study, we considered the possibility of immediate stent migration. Accordingly, surveillance chest x‐ray was routinely scheduled for its detection immediately after and at 12 hours following the procedure. This was also the very reason for which we allowed repositioning or replacement of the esophageal stent during the first 24 hours after its deployment. We chose this time lapse because of the recognized high risk of rebleeding during the first 24 hours, a risk that is known to progressively decrease thereafter.4 As mentioned in the article, one of our patients randomized to receive the esophageal stent actually was treated by a Sengstaken tube because of a defect in the stent delivery system (rupture of the gastric balloon). In addition, 2 patients experienced stent migration, which was detected in the plain chest x‐ray performed immediately after stent deployment. In both instances, stent migration was immediately corrected, by repositioning the stent in 1 case and by removing the migrated stent and placement of a second one in the other case. These were considered technical problems rather than complications, given that none were associated with failure in controlling bleeding or with the development of clinical complications. Admitedly, we do not know whether such an early detection of the stent migration in our 2 patients and its rapid resolution prevented the development of subsequent serious complications. Therefore, we agree with Gundling et al. that migration after the deployment of self‐expanding esophageal metal stents represents a potential complication in the treatment of bleeding esophageal varices. Nevertheless, its consequences may be mitigated by scheduling a plain chest x‐ray immediately after stent deployment and periodically thereafter, because this allows its early recognition and resolution.

Outcomes in variceal hemorrhage following the use of a balloon tamponade device

BackgroundVariceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. MethodsIn this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. Results34 patients with a BTD were identified. Median age was 57.5 (IQR 47–63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p<0.01). One complication, an esophageal perforation, was identified and managed conservatively. ConclusionIn this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy.

Terlipressin Administered Only Prior To Endoscopic Therapy in The Management of Bleeding Esophageal Varices Does Not Increase the Risk of Re-bleeding Compared to Standard 3-5 Days Regime

Background & Aims: Terlipressin is recommended therapy for 3-5 days in esophageal variceal bleeding. The aim of this study was to determine the feasibility of administering terlipressin only prior to band ligation. Methods: Patients with esophageal variceal bleeding received terlipressin 2mg intravenous bolus followed by 1mg 6 hourly until undergoing endoscopic band ligation. They were monitored for re-bleeding for 5 days. Results: 67 patients, 38 (57%) male and 29 (43%) female, mean age 50+4 years, received terlipressin until undergoing endoscopic band-ligation. Etiology of liver disease was HCV in 62 (92.5%), HBV & HCV in 2 (3%), HCV & ethanol in 2 (3%) and unknown in 1 (1.5%) patient. 13 (19%) patients underwent band ligation after a single 2 mg dose of terlipressin, 16 (24%) after two doses (6 hours therapy), 11 (16%) after 3 (12 hours therapy), 6 (9%) after 4 (18 hours therapy), 6 (9%) after 5 doses (24 hours therapy) and 15 (22%) after more than 24 hours therapy. Banding was done within 12 hours in 40 (60%) patients and within 24 hours in 12 (18%) patients. Endoscopy was delayed beyond 24 hours in 15 (22%) patients due to Sengstaken-Blakemore tube placement, encephalopathy and blood transfusion requirements. 3 (4.9%) patients had rebleeding. Repeat endoscopy showed post-banding ulcers in 2 patients (managed with I.V omeprazole and oral sucralfate). One patient had varices with red signs requiring repeat band ligation. Two patients died due to hepatorenal syndrome and persistent encephalopathy. No drug related adverse effects were noted. Conclusion: Once band-ligation has been performed, terlipressin may be safely discontinued. This can result in reduction in cost of treatment with no significant increase in morbidity and mortality.

Application of new sengstaken-blakemore tube in patients with esophageal and gastric variceal bleeding

Objective To explore the effect of new sengstaken-blakemore tube in patients with esophageal and gastric variceal bleeding (EGVB) . Methods A total of 50 patients of liver cirrhosis complicated with EGVB in First Hospital of Jiaxing City were randomly divided into the experimental group (25 patients) and the control group (25 patients) from January 2015 to June 2016. Patients in the experimental group were practiced with new sengstaken-blakemore tube, while patients in the control group were given traditional sengstaken-blakemore tube. The hemostatic effect, the incidence of adverse reactions (nasal skin damage, discomfort of postural restriction, chest tightness, chest pain and dyspnea) and operation satisfaction were compared between two groups. Results The hemostatic efficiency in the control group was lower than that in the experimental group (68% vs 96%) . The differences between two groups were statistically significant (χ2=4.88, P<0.05) . The incidence of nasal skin damage (4 cases) , discomfort of postural restriction (3 cases) , chest tightness (4 cases) , chest pain (13 cases) , and dyspnea (3 cases) in the experimental group were lower than those in the control group (12 cases, 10 cases, 11 cases, 20 cases and 11 cases) (P<0.05) . The operation satisfaction in the experimental group (72.0%) was higher than that (28.0%) in control group (P<0.05) . Conclusions Compared with the traditional sengstaken-blakemore tube, the new sengstaken-blakemore can improve the hemostatic effect, reduce the adverse reactions and increase the operation satisfaction. It is worthy of clinical application. Key words: Innovation and promotion; Hemostasis; Sengstaken-blakemore tube; Esophageal and gastric varices; Robert clip; Pull ring

Application of sengstaken-blakemore tube in laryngeal trauma patient with fracture of cricoid cartilage: a case report

Application of sengstaken-blakemore tube in laryngeal trauma patient with fracture of cricoid cartilage: a case report

PTH-102 Acute Variceal Haemorrhage in The Northwest of England: Patient Characteristics, Management and Outcomes

Introduction Acute variceal haemorrhage (AVH) is associated with significant mortality risk. We conducted a prospective audit of patients admitted with AVH in the Northwest (NW) of England to examine our clinical practice and patient outcomes. Methods We undertook a prospective multi-centre audit of AVH related admissions to 12 NW hospitals between November 2011 to April 2012. Data on patient characteristics, management and outcomes were collated by reviewing hospital records. Adherence with Baveno V consensus guidelines was examined. The findings were compared with 2007 UK Comparative Audit of Upper Gastrointestinal Bleeding (AUGIB).1 Data analysis was performed by considering the frequency distribution of variables and their association with in-hospital mortality and length of stay. Results 102 patients (median age 53 years, 67% male) details were available. More than half the patients were admitted out-of-hours (57%) and 28% were admitted on weekends. The median time to gastroscopy was 1 (IQR 0–1.5) day. Majority of patients were managed by a gastroenterologist (88%) and received Terlipressin (75%) and antibiotics (64%). The median length of stay was 8 (IQR 5–14) days and 13% of patients died during their hospitalisation. The rate of failure to control bleeding within 120 hours was 17% and 19% of the patients had a re-bleed. In total, 5% had Sengstaken tube insertion and 7% had emergency TIPSS insertion. Age over 65 years (p = 0.008) and admission out-of-hours (p = 0.03) was associated with a higher mortality. Failure to control bleeding within 120 hours (p Conclusion The mortality rate, length of hospital stay, use of terlipressin, prophylactic antibiotics, and therapeutic interventions at endoscopy to control AVH appeared to be better than 2007 UK AUGIB report. However, timeliness of endoscopic intervention and adherence to standard guidelines remained deficient in parts across the region. The development of a NW England regional AVH care bundle consisting of an agreed protocol and pathway for emergency TIPSS may help improve patient outcomes. Reference 1 Hearnshaw SA, et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011;60(10):1327–35. Disclosure of Interest None Declared

986 Simulation-Based Training of Minnesota Tube Placement for GI fellows: Utilization of a Mastery Learning Model for Low Volume Procedural Training

986 Simulation-Based Training of Minnesota Tube Placement for GI fellows: Utilization of a Mastery Learning Model for Low Volume Procedural Training

Novel use of a Sengstaken–Blakemore tube during a neck exploration of a carotid injury: A case report

Penetrating neck trauma can injure the major blood vessels, airway, gastrointestinal system, and neurological system. We present a case where a Sengstaken–Blakemore tube was emergently placed during surgical exploration of a stab wound to the neck to tamponade bleeding until surgical control was obtained and the vascular injuries were managed.

Emergency endoscopic variceal ligation following variceal rupture in patients with advanced hepatocellular carcinoma and portal vein tumor thrombosis: a retrospective study.

BackgroundThe outcomes of treatment of ruptured varices in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) are unclear. We therefore evaluated the long- (rebleeding and death) and short-term (immediate death within 24 h of variceal bleeding diagnosis) outcomes of patients with PVTT who underwent emergency variceal band ligation.MethodsData on 62 patients with PVTT and endoscopically proven esophageal or gastric variceal bleeding from 2007 to 2012 were studied. In most cases, the varices were treated using endoscopic variceal band ligation (EVL). We assessed the patients’ rebleeding-free and overall survival using the Kaplan-Meier method, and a Cox proportional hazard model was used to analyze effect of independent factors on rebleeding-free and overall survival times.ResultsMost patients had decompensated cirrhosis and were classified as Child-Pugh class B (56 %) or C (36 %). A total of 35 patients (56 %) had PVTT in the main portal trunk. Among all patients, 58 (94 %) and 4 (6 %) had esophageal and gastric variceal bleeding, respectively. Bleeding was managed using EVL in all, but one patient (98 %) who was treated with a Sengstaken-Blakemore tube. A total of 24 patients (39.3 %) experienced rebleeding, and these patients had a median overall survival time of 36 days. A PVTT in the main portal trunk was predictive of rebleeding (hazard ratio 3.706, p = .0223), and α-fetoprotein-L3 levels <37.4 % (hazard ratio 0.464, p = 0.015) and Child-Pugh class A/B (hazard ratio 0.398, p = 0.007) were associated with overall survival. We observed 95 bleeding events in 62 patients. EVL achieved hemostasis in 92 of the 95 bleeding events, whereas seven immediate deaths occurred due to variceal bleeding (7/92, 7.6 %). All three bleeding events treated with modalities other than EVL resulted in immediate deaths.ConclusionsEVL is a safe and effective treatment of variceal ruptures in patients with HCC and PVTT. After successful hemostasis, alleviation of the underlying liver function impairment and tumor control are equally important for a good prognosis.

Tracheal rupture after misplacement of Sengstaken-Blakemore tube

Tracheal rupture after misplacement of Sengstaken-Blakemore tube