Efficacy of balloon tamponade in treatment of bleeding gastric and esophageal varices
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The efficacy and complications of esophageal tamponade as the first procedure in the routine management of acute variceal hemorrage were evaluated in 151 consecutive bleeding episodes treated at a specialized unit. The Sengstaken-Blakemore tube was employed in the 118 cases in which emergency endoscopy demonstrated bleeding esophageal varices, and the Linton-Nachlas balloon in the 33 cases with bleeding from gastric varices. Hemostasis lasting at least 24 hr was obtained in 91.5% of cases treated with the Sengstaken- Blakemore balloon and in 88% of those treated with the Linton-Nachlas balloon. Permanent hemostasis was obtained in 47.7% of all cases. The only severe complication noted in these 151 episodes of bleeding treated by tamponade was pulmonary aspiration, which was detected in 10% of cases. This complication was related to the presence and degree of encephalopathy (P<0.001 and was prevented by orotracheal intubation prior to tamponade. These results indicate that balloon tamponade continues to be a reliable and valuable method to arrest bleeding from esophagogastric varices.
Key wordshemorrhage esophagus tamponade varices portal hypertension
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