Sengstaken-Blakemore tube

Sengstaken-Blakemore tube
Intervention
ICD-9-CM	96.06

Sengstaken-Blakemore tube with four lumens

Scheme of using the tube. There are sphygmomanometer drains connected with esophageal port, to enable inflating the balloon with correct pressure.

A Sengstaken-Blakemore tube is a medical device inserted through the nose or mouth and used occasionally in the management of upper gastrointestinal hemorrhage due to esophageal varices (distended and fragile veins in the esophageal wall, usually a result of cirrhosis). The use of the tube was originally described in 1950,^[1] although similar approaches to bleeding varices were described by Westphal in 1930.^[2] With the advent of modern endoscopic techniques which can rapidly and definitively control variceal bleeding, Sengstaken-Blakemore tubes are rarely used at present.^[3]

The device consists of a flexible plastic tube containing several internal channels and two inflatable balloons. Apart from the balloons, the tube has an opening at the bottom (gastric tip) of the device. More modern models also have an opening near the upper esophagus; such devices are properly termed Minnesota tubes.^[4][3] It is passed down into the oesophagus and the gastric balloon is inflated inside the stomach. A traction of 1 kg is applied to the tube so that the gastric balloon will compress on the gastroesophageal junction to reduce the blood flow to esophageal varices. If the use of traction alone cannot stop the bleeding, the esophageal balloon is also inflated to help stop the bleeding. The gastric lumen is for aspirating stomach contents.

Generally it is used only in emergencies where bleeding from presumed varices is impossible to control by administration of medication. It may be difficult to position, particularly in an unwell patient, and may inadvertently be inserted in the trachea, hence endotracheal intubation before the procedure is strongly advised to secure the airway. The tube is often kept in the refrigerator in the hospital's emergency department, intensive care unit and gastroenterology ward. It is a temporary measure: ulceration and rupture of the esophagus and stomach are recognized complications.^[4][5]

A related device with a larger gastric balloon capacity (about 500 ml), the Linton-Nachlas tube, is used for bleeding gastric varices. It does not have an esophageal balloon.

References

1. ^ Sengstaken RW, Blakemore AH (1950). "Balloon tamponage for the control of hemorrhage from esophageal varices". Ann Surg 131 (5): 781–9. doi:10.1097/00000658-195005000-00017. PMC 1616705. PMID 15411151. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1616705. 
2. ^ Westphal K (1930). "Ueber eine Kompressionsbehandlung der Blutungen aus Oesophagusvarizen". Deutsch Med Wochenschr 56 (27): 1135. 
3. ^ ^{a b} Treger R, Graham TP, Dea SK (May 17, 2009). "Sengstaken-Blakemore Tube". Medscape. http://emedicine.medscape.com/article/81020-overview. Retrieved February 2, 2011. 
4. ^ ^{a b} Bauer JJ, Kreel I, Kark AE (1974). "The use of the Sengstaken-Blakemore tube for immediate control of bleeding esophageal varices". Ann Surg 179 (3): 273–7. doi:10.1097/00000658-197403000-00005. PMC 1355886. PMID 4544329. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1355886. Full text at PMC: 1355886
5. ^ Chien JY, Yu CJ (2005). "Images in clinical medicine. Malposition of a Sengstaken-Blakemore tube". N. Engl. J. Med. 352 (8): e7. doi:10.1056/NEJMicm040003. PMID 15728803. 

External links

• Sengstaken Blakemore tube Insertion Video
• GP notebook
• MedAU