Limitations and dangers of the Sengstaken-Blakemore tube in the treatment of hemorrhage from gastric varices

Abstract

Gastric varices are frequent in children with portal hypertension, particularly in patients with portal vein thrombosis. The relation between the presence of gastric varices and the risk of bleeding has not yet been investigated; these are not taken into account when calculating the risk of bleeding according to Beppu's criteria. Gastric varices may be the site of a sudden hemorrhage, either primarily or after sclerotherapy of esophageal varices. Mechanical compression of bleeding esophageal varices by means of a Sengstaken-Blakemore tube is known to be effective in the few patients who fail to respond to intensive medical management. When the source of the bleeding is located on the fundal wall, far from the cardia, the inferior balloon of the Sengstaken-Blakemore tube has no chance of being effective. Furthermore, it may worsen the hemorrhage by a direct stripping effect on fundal varices following efforts to vomit or by enhancing the venous pressure gradient. The inappropriate employment of this tube may ultimately result in fatalities. For bleeding gastric varices, the Linton-Nachlas tube is more indicated. It is very important to understand its correct use as well its limitations.