Sengstaken-Blakemore tube

Sengstaken-Blakemore tube is a medical device used in the management of upper gastrointestinal bleeding due to esophageal varices. It was designed by Robert W. Sengstaken and Arthur H. Blakemore in 1950 as a means to control bleeding by applying direct pressure to the source of hemorrhage. This article provides an overview of the Sengstaken-Blakemore tube, including its design, indications, procedure, complications, and alternatives.

Design

The Sengstaken-Blakemore tube is a specialized nasogastric tube that features three lumens and two inflatable balloons. The tube is designed to be inserted through the nose (nasally) or mouth (orally) into the stomach. The distal balloon, known as the gastric balloon, is positioned in the stomach and inflated to exert pressure on the gastric fundus to control bleeding. The proximal balloon, known as the esophageal balloon, is positioned in the esophagus and can be inflated to apply pressure against esophageal varices. The third lumen is used for aspiration of gastric contents to prevent aspiration pneumonia.

Indications

The primary indication for the use of a Sengstaken-Blakemore tube is the control of acute variceal hemorrhage when other treatments, such as pharmacotherapy or endoscopic therapy, are not available, have failed, or are contraindicated. It is considered a temporary measure until definitive treatment can be administered.

Procedure

The insertion of a Sengstaken-Blakemore tube is a critical procedure that requires careful preparation and monitoring. The patient is typically sedated, and the tube is inserted nasally or orally into the stomach. The gastric balloon is then inflated with air or saline, and its position is confirmed by radiography or endoscopy. If bleeding continues, the esophageal balloon is inflated to apply pressure against the esophageal varices. The tube is secured in place, and continuous monitoring is essential to ensure the effectiveness of the treatment and to prevent complications.

Complications

Complications associated with the Sengstaken-Blakemore tube include aspiration pneumonia, esophageal rupture, airway obstruction, and mucosal necrosis. These complications are potentially life-threatening and require immediate attention.

Alternatives

Alternatives to the Sengstaken-Blakemore tube include the Minnesota tube and the Linton-Nachlas tube, which are similar in design but have different configurations of balloons and lumens. Endoscopic treatments, such as variceal ligation or sclerotherapy, and pharmacological therapies are also effective alternatives for the management of variceal bleeding.

Conclusion

The Sengstaken-Blakemore tube is a critical tool in the management of acute variceal hemorrhage in the upper gastrointestinal tract. While it is effective in controlling bleeding, its use is associated with significant risks and complications. It is considered a temporary measure until definitive treatment can be administered. Healthcare providers must be aware of the indications, procedure, and potential complications associated with its use.