Sengstaken–Blakemore tube

Sengstaken-Blakemore tube EN

Sengstaken–Blakemore tube is a medical device used in the management of upper gastrointestinal bleeding due to esophageal varices. Esophageal varices are dilated submucosal veins in the esophagus, often secondary to portal hypertension, which can rupture and lead to life-threatening hemorrhages. The Sengstaken–Blakemore tube is specifically designed to provide tamponade (pressure) to bleeding varices in the esophagus and stomach.

Design and Function

The Sengstaken–Blakemore tube is a specialized nasogastric tube that features three lumens and two inflatable balloons. The tube is inserted through the nose (nasally) or mouth (orally) into the stomach. Once in place, the gastric balloon is inflated within the stomach to exert pressure on the bleeding varices at the gastroesophageal junction. The esophageal balloon can be inflated to apply direct pressure to bleeding varices in the lower esophagus. The third lumen is used for aspiration, allowing for the removal of gastric contents above the gastric balloon.

Indications

The primary indication for the use of a Sengstaken–Blakemore tube is the control of acute variceal hemorrhage when other measures, such as pharmacotherapy or endoscopic interventions, are not available, have failed, or are contraindicated. It is considered a temporary measure until definitive treatment, such as endoscopic variceal ligation (EVL) or transjugular intrahepatic portosystemic shunt (TIPS), can be performed.

Procedure

The insertion of a Sengstaken–Blakemore tube is an emergency procedure that requires careful preparation and monitoring. The patient should be in a monitored setting, ideally in an intensive care unit (ICU), due to the risk of complications such as aspiration, airway obstruction, or esophageal rupture. The tube is lubricated and inserted nasally or orally, advanced into the stomach, and then the gastric balloon is inflated. Correct placement of the tube and balloons is confirmed through imaging or endoscopy. Once the gastric balloon is confirmed to be in the correct position, it is filled with air or water to the recommended volume, and traction is applied to tamponade the bleeding varices. If necessary, the esophageal balloon is then inflated to apply additional pressure.

Complications

Complications associated with the Sengstaken–Blakemore tube include aspiration pneumonia, esophageal rupture, airway obstruction, and necrosis of the esophageal or gastric mucosa due to excessive pressure from the balloons. Therefore, its use requires careful patient selection and close monitoring.

History

The Sengstaken–Blakemore tube was developed in the 1950s by Robert W. Sengstaken and Arthur H. Blakemore as a means to control hemorrhage from esophageal varices. It represented a significant advancement in the management of gastrointestinal bleeding at the time.

Current Use

With the advent of more effective and less invasive treatments, such as pharmacologic therapy and endoscopic techniques, the use of the Sengstaken–Blakemore tube has declined. However, it remains an important tool in specific situations where other treatments are not feasible or have failed, particularly in settings where immediate access to advanced endoscopic or radiologic interventions is not available.