Digestive Diseases and Sciences

, Volume 25, Issue 4, pp 267–272 | Cite as

Esophageal tamponade in the treatment of bleeding varices

A decadal progress report
  • Mario Chojkier
  • Harold O. Conn
Original Articles


Previous reports from this hospital in 1958 and 1967 have revealed that esophageal tamponade is a relatively dangerous type of treatment. Other investigators have been able to avoid many of the hazards of this technique. We have again assessed our results in 50 episodes of esophageal tamponade in bleeding esophageal varices in 39 patients. Thirty-seven had alcoholic cirrhosis, one Wilson's disease, and one portal vein thrombosis. The diagnosis of variceal hemorrhage was established by endoscopy or angiography in virtually all. The great majority (86%) had had unsuccessful infusions of vasopressin previously. The Sengstaken-Blakemore tube (SBT) was used in 41 and the Linton tube (LT) in nine. Hemorrhage was controlled for at least 24 consecutive hours in 20 episodes (40%). Ninety percent of the patients died. Rupture of the esophagus following inflation of the gastric balloon in the esophagus caused three deaths (8%). Major nonfatal complications such as aspiration pneumonia occurred on five other occasions. Although the complications of esophageal tamponade were greatly reduced from our previous series, the efficacy of esophageal tamponade also decreased. There were no significant differences in the efficacy or complications of the SBT and LT. The high mortality and complication rates are still discouraging. We believe that the role of esophageal tamponade in the treatment of hemorrhage from varices is a secondary one.


Pneumonia High Mortality Complication Rate Portal Vein Vasopressin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Conn HO: Hazards attending the use of esophageal tamponade. N Engl J Med 259:701–707, 1958Google Scholar
  2. 2.
    Conn HO, Simpson JA: Excessive mortality associated with balloon tamponade of bleeding varices. J Am Med Assoc 202:587–591, 1967Google Scholar
  3. 3.
    Bertrand L, Michel H: La Sonde de Linton-Nachlas. Sa supéricrité sur celle de Sengstaken-Blakemore pour le tamponnement des varices oesogastriques chez le cirrhotique. Arch Fr Mal App Dig 58:797–816, 1969Google Scholar
  4. 4.
    Hermann RE, Traul D: Experience with the Sengstaken-Blakemore tube for bleeding esophageal varices. Surg Gynecol Obstet 130:879–885, 1970Google Scholar
  5. 5.
    Pitcher JL: Safety and effectiveness of the modified Sengstaken-Blakemore tube: A prospective study. Gastroenterology 61:291–298, 1971Google Scholar
  6. 6.
    Johansen TS, Baden H: Re-appraisal of the Sengstaken-Blakemore balloon tamponade for bleeding esophageal varices; results in 91 patients. Scand J Gastroenterol 8:181–183, 1973Google Scholar
  7. 7.
    Mardomingo Varela P, Cosme A, Muro J, Cano JM, Ortiz-Vázquez J: Utilidad de la sóndabalon de Sengstaken-Blakemore. Estudio Prospectivo. Rev Esp Enferm Apar Dig 39:283–298, 1973Google Scholar
  8. 8.
    Bauer JJ, Kreel I, Kark AE: The use of the Sengstaken-Blakemore tube for immediate control of bleeding esophageal varices. Ann Surg 179:273–277, 1974Google Scholar
  9. 9.
    Burcharth F, Malmstrøm J: Experiences with the Linton-Nachlas and the Sengstaken-Blakemore tubes for bleeding esophageal varices. Surg Gynecol Obstet 142:529–531, 1976Google Scholar
  10. 10.
    Novis BH, Duys P, Barbezat GO, Clain J, Bank S, Terblanche J: Fibreoptic endoscopy and the use of the Sengstaken tube in acute gastrointestinal haemorrhage in patients with portal hypertension and varices. Gut 17:258–263, 1976Google Scholar
  11. 11.
    Teres J, Cecilia A, Bordas JM, Rimola A, Bru C, Rodes J: Esophageal tamponade for bleeding varices. Controlled trial between the Sengstaken-Blakemore tube and the Linton-Nachlas tube. Gastroenterology 75:566–569, 1978Google Scholar
  12. 12.
    Conn HO, Dalessio DJ: Multiple infusions of posterior pituitary extract in the treatment of bleeding esophageal varices. Ann Intern Med 57:804–809, 1962Google Scholar
  13. 13.
    Conn HO, Ramsby GR, Storer EH: Selective intra-arterial vasopressin in the treatment of upper gastrointestinal hemorrhage. Gastroenterology 53:634–645, 1972Google Scholar
  14. 14.
    Conn HO, Ramsby GR, Storer EH, Mutchnick MG, Joshi PH, Phillips MM, Cohen GA, Fields GN, Petroski D: Intra-arterial vasopressin in the treatment of upper gastrointestinal hemorrhage: A prospective, controlled clinical trial. Gastroenterology 68:211–221, 1975Google Scholar
  15. 15.
    Chojkier M, Groszmann RJ, Atterbury CE, Bar-Meir S, Blei AT, Frankel J, Glickman MG, Kniaz JL, Schade R, Taggart GJ, Conn HO: A controlled comparison of continuous intra-arterial and intravenous infusions of vasopressin in hemorrhage from esophageal varices. Gastroenterology 77:540–546, 1979Google Scholar
  16. 16.
    Paquet KJ, Oberhammer E: Schlerotherapy of bleeding oesophageal varices by means of endoscopy. Endoscopy 10:7–12, 1978Google Scholar
  17. 17.
    Viamonte M Jr, Pereiras R, Russell E, LePage J, Hutson D: Transhepatic obliteration of gastroesophageal varices: Results in acute and nonacute bleeders. Am J Roentgenol 129:237–241, 1977Google Scholar
  18. 18.
    Orloff MJ, Duguay LR, Kosta LD: Criteria for selection of patients for emergency portacaval shunt. Am J Surg 134:146–152, 1977Google Scholar
  19. 19.
    Boyce HW, Jr: Modification of the Sengstaken-Blakemore balloon tube. N Engl J Med 267:195–196, 1962Google Scholar

Copyright information

© Digestive Disease Systems, Inc. 1980

Authors and Affiliations

  • Mario Chojkier
    • 1
    • 2
  • Harold O. Conn
    • 1
    • 2
  1. 1.Liver Disease LaboratoryVeterans Administration Medical CenterWest Haven
  2. 2.Yale University School of MedicineNew Haven

Personalised recommendations