Advertisement

Digestive Diseases and Sciences

, Volume 33, Issue 4, pp 454–459 | Cite as

Efficacy of balloon tamponade in treatment of bleeding gastric and esophageal varices

Results in 151 consecutive episodes
  • J. Panés
  • J. Terés
  • J. Bosch
  • J. Rodés
Original Articles

Abstract

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 words

hemorrhage esophagus tamponade varices portal hypertension 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sengstaken RW, Blakemore AH: Balloon tamponade for the control of hemorrhage from esophageal varices. Ann Surg 131:781–789, 1950PubMedGoogle Scholar
  2. 2.
    Nachlas MM: A new triple lumen tube for the diagnosis and treatment of upper gastrointestinal hemorrhage. N Engl J Med 252:720–721, 1955PubMedGoogle Scholar
  3. 3.
    Terés J, Cecilia A, Bordas JM, Rimola A, Bru C, Rodés J: Esophageal tamponade for bleeding varices. Controlled trial between the Sengstaken-Blakemore tube and the Linton-Nachlas tube. Gastroenterology 75:566–569, 1978PubMedGoogle Scholar
  4. 4.
    Boyce HW: Modification of the Sengstaken-Blakemore balloon tube. N Engl J Med 267:195–196, 1960Google Scholar
  5. 5.
    Hunt PS, Korman MG, Hansky J, Parkin WG: An 8-year prospective experience with balloon tamponade in emergency control of bleeding esophageal varices. Dig Dis Sci 27:413–416, 1982PubMedGoogle Scholar
  6. 6.
    Johansen TS, Baden H: Reappraisal of the Sengstaken-Blakemore balloon tamponade for bleeding esophageal varices; results in 91 patients. Scand J Gastroenterol 8:181–183, 1973PubMedGoogle Scholar
  7. 7.
    Novis BH, Duys P, Barbezat GO, Clain J, Bank S, Terblanche J: Fiberoptic endoscopy and the use of the Sengstaken tube in acute gastrointestinal haemorrhage in patients with portal hypertension and varices. Gut 17:258–263, 1976PubMedGoogle Scholar
  8. 8.
    Chojkier M, Conn HO: Esophageal tamponade in the treatment of bleeding varices. A decadal progress report. Dig Dis Sci 25:267–272, 1980PubMedGoogle Scholar
  9. 9.
    Mardomingo P, Cosme A, Muro J, Cano JM, Ortiz-Vazquez J: Utilidad de la sonda-balon de Sengstaken-Blakemore. Estudio prospectivo. Rev Esp Enferm Apar Dig 49:283–298, 1973Google Scholar
  10. 10.
    Conn HO, Simpson JA: Excessive mortality associated with balloon tamponade of bleeding varices. JAMA 202:587–591, 1967PubMedGoogle Scholar
  11. 11.
    Pitcher JL: Safety and effectiveness of the modified Sengstaken-Blakemore tube: A prospective study. Gastroenterology 61:291–298, 1971PubMedGoogle Scholar
  12. 12.
    Herman RE, Traul D: Experience with the Sengstaken-Blakemore tube for bleeding esophageal varices. Surg Gynecol Obstet 130:879–885, 1970PubMedGoogle Scholar
  13. 13.
    Bertrand L, Michel H: La sonde de Linton-Nachlas. Sa superiorité sur celle de Sengstaken-Blakemore pour le tamponement des varices oesogastriques chez le cirrhotique. Arch Fr Mal Appar Dig 58:797–816, 1969Google Scholar
  14. 14.
    Merigan TC, Plotkin GR, Davidson CS: Effect of intravenously administered posterior pituitary extract on hemorrhage from bleeding esophageal varices. A controlled evaluation. N Engl J Med 266:134–135, 1962PubMedGoogle Scholar
  15. 15.
    Johnston GW, Rodgers HW: A review of 15 years experience in the use of sclerotherapy in the control of acute haemorrhage from oesophageal varices. Br J Surg 60:797–800, 1973PubMedGoogle Scholar
  16. 16.
    Rimola A, Bory F, Terés J, Pérez-Ayuso RM, Arroyo V, Rodés J: Oral nonabsorbable antibiotics prevent infection in cirrhosis with gastrointestinal hemorrhage. Hepatology 5:463–467, 1985PubMedGoogle Scholar
  17. 17.
    Campbell DP, Parker DE, Anagnostopoulos CE: Survival prediction in portocaval shunts: A computerized statistical analysis. Am J Surg 126:748–751, 1973PubMedGoogle Scholar
  18. 18.
    Orloff MJA: Emergency portocaval shunt. Ann Surg 166:456–478, 1967PubMedGoogle Scholar
  19. 19.
    Graham DY, Smith JL: The course of patients following variceal hemorrhage. Gastroenterology 80:800–809, 1981PubMedGoogle Scholar
  20. 20.
    Pinto-Correia J, Martins-Alves M, Alexcandrino P, Silveira J: Controlled trial of vasopressin and balloon tamponade in bleeding esophageal varices. Hepatology 4:885–88, 1984PubMedGoogle Scholar
  21. 21.
    Johnson WC, Widrich WC, Ansell JE, Robbins AH, Nabseth DC: Control of bleeding varices by vasopressin. A prospective randomized study. Ann Surg 186:369–376, 1977PubMedGoogle Scholar
  22. 22.
    Kravetz D, Bosch J, Terés J, Bruix J, Rimola A, Rodés J: Comparison of intravenous somatostatin and vasopressin infusions in the treatment of acute variceal hemorrhage. Hepatology 4:442–446, 1984PubMedGoogle Scholar
  23. 23.
    Freeman JG, Cobden I, Lishman AH, Record CO: Controlled trial of Terlipressin (glypresin) versus vasopressin in the early treatment of oesophageal varices. Lancet 2:66–68, 1982PubMedGoogle Scholar
  24. 24.
    Gimson AES, Westaby D, Hegarty J, Watson A, Williams R: A randomized trial of vasopressin and vasopressin plus nitroglycerin in the control of acute variceal hemorrhage. Hepatology 6:410–413, 1986PubMedGoogle Scholar
  25. 25.
    Paquet KJ, Feussner H: Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: A prospective controlled randomized trial. Hepatology 5:580–583, 1985PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1988

Authors and Affiliations

  • J. Panés
    • 1
  • J. Terés
    • 1
  • J. Bosch
    • 1
  • J. Rodés
    • 1
  1. 1.Liver UnitHospital Clínic i Provincial, Medical SchoolBarcelonaSpain

Personalised recommendations