Use Of Sengstaken-Blakemore Tube Research Articles

Treatment of acute esophageal variceal bleeding in cirrhotic patients

Esophageal variceal bleeding is the most dangerous complication in cirrhotic patients and is accompanied by high mortality. Treatment strategy involves early diagnosis, maintaining vital body functions and specific therapy aimed at the provision of local hemostasis and reduction of portal pressure. To this end, it is currently recommended to combine vasoactive drug (mainly, terlipressin or somatostatin) therapy with endoscopic methods of hemostasis (sclerotherapy or ligation). The use of Sengstaken-Blakemore tube is appropriate only in cases of refractory bleeding if the above methods cannot be used. An alternative to balloon tamponade may be the installation of self-expandable metal stents. Although transjugular intrahepatic portosystemic shunting is an extremely useful technique for the treatment of acute bleeding from esophageal varices, currently it is viewed as second-line therapy. Urgent surgical intervention is rarely performed and can be considered only in case of failure of conservative and/or endoscopic therapy and being unable to use a transjugular intrahepatic portosystemic shunt for technical or organizational reasons or due to anatomic problems. Among surgical operations described in the literature are various kinds of portocaval anastomoses and azygoportal disconnection procedure. To improve the results of treatment of cirrhotic patients with acute esophageal variceal bleeding it seems important to stratify them by risk groups, which will allow one to tailor therapeutic approaches to the expected results. For example, to initiate early use of more aggressive methods in patients with predictors of poor outcomes, and to protect individuals with a good prognosis from unnecessary invasive procedures. It is hoped that further research will refine this hypothesis.

Endoscopic treatment of bleeding gastric varices with histoacryl (N-butyl-2-cyanoacrylate): a South European single center experience

Endoscopic injection of N-butyl-2-cyanoacrylate is the current recommended treatment for gastric variceal bleeding. Despite the extensive worldwide use, there are still differences related to the technique, safety, and long term-results. We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients with gastric variceal bleeding. Between January 1998 and January 2010, 97 patients with gastric variceal bleeding underwent endoscopic treatment with a mixture of N-butyl-2-cyanoacrylate and Lipiodol(TM). Ninety-one patients had cirrhosis and 6 had non-cirrhotic portal hypertension. Child-Pugh score at presentation for cirrhotic patients was A-12.1 %; B-53.8 %; C-34.1 % and median MELD score at admission was 13 (3-26). Successful hemostasis, rebleeding rate and complications were reviewed. Median time of follow up was 19 months (0.5-126). A median mixture volume of 1.5 mL (0.6 to 5 mL), in 1 to 8 injections, was used, with immediate hemostasis rate of 95.9 % and early rebleeding rate of 14.4 %. One or more complications occurred in 17.5 % and were associated with the use of Sengstaken-Blakemore tube before cyanoacrylate and very early rebleeding (p < 0.05). Hospital mortality rate during initial bleeding episode was 9.3 %. Very early rebleeding was a strong and independent predictor for in-hospital mortality (p < 0.001). Long-term mortality rate was 58.8 %, in most of the cases secondary to hepatic failure. N-butyl-2-cyanoacrylate is a rapid, easy and highly effective modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate. Patients with very early rebleeding are at higher risk of death.

Minnesota Tube for Bleeding Rectal Varices

A 51 year old man with Child's C hepatitis C cirrhosis, paroxysmal atrial fibrillation was admitted with decompensated cirrhosis, increasing ascites, and hepatic encephalopathy. As a part of pre-transplant work-up, he underwent colonoscopy which showed polyps in the descending colon as well as non bleeding rectal varices. Polypectomy was performed with no immediate complications. Within 24 hours of discharge, he presented with bright red rectal bleeding which led to hemorrhagic shock and admission to the intensive care unit, requiring massive blood and blood products transfusion. Emergency mesenteric angiogram was non-diagnostic. Despite the correction of his coagulopathy, he continued to bleed requiring emergent laparotomy, left hemicolectomy, and colostomy. Post operatively he had another episode of bleeding and he was taken back to OR for ligation of feeding vessels to rectal varices in addition to intra and extraluminal packing. In the interim, he underwent TIPS procedure for portal hypertension. One day later he returned to OR to have the packings removed, only to find the rectal varices still oozing. It was decided to place Minnesota tube to apply direct pressure using inflated gastric balloon to rectal varices. Due to the presence of rectal stump, which was around 15 cm, 10cm of the tube was cut. The tube was inserted into the rectal stump and gastric balloon was inflated with 200mls of air with immediate cessation of bleeding. The gastric aspiration port was aspirated every 2 hours. The balloon remained inflated for the next 24 hours with no evidence of further bleeding. Discussion: Minnesota tube can be used as rescue treatment for bleeding rectal varices when all other modes of therapy failed to stop bleeding. There has been similar case reports describing the use of Sengstaken-Blakemore tube in patients with rectal bleeding due to angiodysplasia, post partum hemorrhage. However, this is the first case that describes the use of Minnesota tube which has a larger gastric balloon in patient with rectal bleeding due to varices. [figure 1]Figure 1

Use of Sengstaken-Blakemore Tube in Massive Postpartum Hemorrhage: A Series of 17 Cases

Use of Sengstaken-Blakemore Tube in Massive Postpartum Hemorrhage: A Series of 17 Cases

Use of Sengstaken-Blakemore Tube in Massive Postpartum Hemorrhage: A Series of 17 Cases

Use of Sengstaken-Blakemore Tube in Massive Postpartum Hemorrhage: A Series of 17 Cases

Use of Sengstaken-Blakemore tube in massive postpartum hemorrhage: a series of 17 cases

Background. To evaluate the efficacy and identify the indications of intrauterine tamponade with a Sengstaken–Blakemore tube in acute postpartum hemorrhage. Methods. Retrospective study was performed in 17 female patients with massive postpartum hemorrhage despite appropriate medical treatment, and requiring surgery (embolization techniques were not available in our hospital). Patients were treated by inserting a Sengstaken–Blakemore tube in the uterus through the vagina in case of vaginal delivery or through the hysterotomy incision in case of cesarean section. The esophageal balloon was inflated with 250 ml of isotonic saline solution. Patients underwent regional or general anesthesia. A preventive treatment with broad-spectrum antibiotics was systematically administered. Results. Tamponade treatment prevented surgery in 88% of patients, hemorrhage was controlled in 71% of cases (reducing the need for embolization by 80%), and waiting for a transfer for embolization was made possible for 18% of patients. Conclusion. Intrauterine tamponade with a Sengstaken–Blakemore tube appears as a simple, low-cost, readily available and effective means of treating life-threatening postpartum hemorrhage. The only apparent contraindication is the discovery of an infection during delivery.

Use of Sengstaken-Blakemore Tube to Stop Massive Upper Gastrointestinal Bleeding from Dieulafoy's Lesion in the Lower Oesophagus

Massive upper gastrointestinal bleeding from Dieulafoy's lesion in the gastrointestinal tract is uncommon. The use of the Sengstaken-Blakemore tube in acute gastrointestinal bleeding has become less common since endoscopic sclerotherapy and banding procedures have become widely available. The successful use of a Sengstaken-Blakemore tube to control acute massive upper gastrointestinal bleeding from a Dieulafoy's lesion in the lower oesophagus in an elderly man with severe coronary artery disease and heart failure is described.

Rupture of Esophagus During Use of Sengstaken-Blakemore Tube

"Rupture of Esophagus During Use of Sengstaken-Blakemore Tube." Postgraduate Medicine, 56(2), pp. 199–200

Letter: Unusual complication of use of Sengstaken-Blakemore tube.

Letter: Unusual complication of use of Sengstaken-Blakemore tube.