An 8-year prospective experience with balloon tamponade in emergency control of bleeding esophageal varices
- 30 Downloads
The use of balloon tamponade in the emergency control of bleeding from esophageal varices is controversial. This paper reports a prospective study over an 8-year period in which balloon tamponade has been the sole means employed for the early control of bleeding varices. During 1972–1980 all patients referred to Prince Henry's Hospital with upper gastrointestinal bleeding were admitted to a special unit. Ninety-one had bleeding esophageal varices, and 17 were admitted on one or more occasions for bleeding for a total of 132 admissions. After early endoscopy, balloon tamponade was used during 103 of these admissions with failure to control bleeding on six occasions; five of these patients died from hemorrhage and the sixth recovered after emergency portacaval shunt. Another patient died from rebleeding not treated by tamponade. Reinsertion of the balloon for rebleeding was necessary on 28 occasions with successful control in all cases. Balloon tamponade was not used during 29 admissions because bleeding had ceased or the patient was considered to have terminal liver disease. In this group there were four deaths from severe liver disease and hemorrhage. Balloon tamponade was used in 78% of admissions and controlled bleeding in more than 90% of patients. This suggests that tamponade may be the method of choice for early control of bleeding from esophageal varices.
KeywordsLiver Disease Gastrointestinal Bleeding Esophageal Varix Severe Liver Special Unit
Unable to display preview. Download preview PDF.
- 1.Orloff MJA: Emergency portacaval shunt. Ann Surg 166:456–478, 1967Google Scholar
- 2.Conn HO, Simpson JA: Excessive mortality associated with balloon tamponade of bleeding varices. J Am Med Assoc 202:587–591, 1967Google Scholar
- 3.Orloff MJ, Bell RH, Hyde PV, Skiveleki WP: Long term results of emergency portacaval shunt for bleeding esophageal varices in unselected patients with alcoholic cirrhosis, Ann Surg 192:325–340, 1980Google Scholar
- 4.Chojkier M, Conn HO: Esophageal tamponade in the treatment of bleeding varices. Dig Dis Sci 25:267–272, 1980Google Scholar
- 5.Bauer JJ, Kreel I, Kark AE: The use of the Sengstaken-Blackmore tube for immediate control of bleeding esophageal varices. Ann Surg 179:273–277, 1974Google Scholar
- 6.Hermann RE, Traul D: Experience with the Sengstaken-Blackmore tube for bleeding esophageal varices. Surg Gynecol Obstet 130:879–885, 1970Google Scholar
- 7.Pitcher JL: Safety and effectiveness of the modified Sengstaken-Blackmore tube: A prospective study. Gastroenterology 61:291–298, 1971Google Scholar
- 8.Ramsburgh SR, Turcotte JG: Control of gastroesophageal variceal bleeding with balloon tamponade.In Upper Gastrointestianl Hemorrhage. RF Green, J Turcotte (eds). New York, Grune & Stratton, 1980, pp 286–290Google Scholar
- 9.Stephen M, Little JM: Bleeding esophageal varices. Aust NZ J Surg 48:162–166, 1978Google Scholar