Original Article

Innovative Technique for Endoscopic Placement of Sengstaken-Blakemore Tube

Authors: Arleen M. Ortiz, MD, Cesar J. Garcia, MD, Mohamed O. Othman, MD, Marc J. Zuckerman, MD

Abstract

Objectives: The Sengstaken-Blakemore (SB) tube is used in cases of uncontrolled variceal bleeding. Because of the complexity of the procedure and the lack of visualization, various techniques have been described to avoid blind placement. We report an innovative and simple technique for placement of the SB tube under direct endoscopic visualization.

Methods: A grasp-and-place technique for endoscopic placement of SB tubes is described and a retrospective cohort study chart review of endoscopies done for variceal bleeding in our medical center is reported. All patients with uncontrolled variceal bleeding who required placement of an SB tube from July 1, 2013 through December 31, 2015 were included. The primary outcome analyses were technical success of tube placement and achievement of hemostasis.

Results: Of 143 endoscopies done for variceal bleeding, 10 were managed with SB tubes placed endoscopically after initial endoscopic therapy was unsuccessful. Successful placement of the tube was achieved in all of the patients. Hemostasis was achieved in 9 of the 10 patients.

Conclusions: We propose a new grasp-and-place technique for endoscopic placement of SB tubes. Review of our experience shows that massive variceal bleeding can be managed effectively with this technique.

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References

1. Hwang JH, Shergill AK, Acosta RD, et al. The role of endoscopy in the management of variceal hemorrhage. Gastrointest Endosc 2014;80: 221-227.
 
2. Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46:922-938.
 
3. Sengstaken RW, Blakemore AH. Balloon tamponage for the control of hemorrhage from esophageal varices. Ann Surg 1950;131:781-789.
 
4. Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Dig Dis 2016;34:382-386.
 
5. Kim MY, Um SH, Baik SK, et al. Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data. Clin Mol Hepatol 2013;19:36-44.
 
6. Sorbi D, Gostout CJ, Peura D, et al. An assessment of the management of acute bleeding varices: a multicenter prospective member-based study. Am J Gastroenterol 2003;98:2424-2434.
 
7. Lin TC, Bilir BM, Powis ME. Endoscopic placement of Sengstaken-Blakemore tube. J Clin Gastroenterol 2000;31:29-32.
 
8. Kaza CS, Rigas B. Rapid placement of the Sengstaken-Blakemore tube using a guidewire. J Clin Gastroenterol 2002;34:282.
 
9. Duarte B. Technique for the placement of the Sengstaken-Blakemore tube. Surg Gynecol Obstet 1989;168:449-450.
 
10. Schlichting AB, Gardner-Gray JM, Hurst G. Novel use of glidescope indirect laryngoscopy for insertion of a Minnesota tube for variceal bleeding. J Emerg Med 2015;49:40-42.
 
11. Tapper EB, Beste L, Curry M, et al. Suboptimal implementation of evidence-based therapy for acute variceal hemorrhage: a systematic review of observational studies. Clin Gastroenterol Hepatol 2017;15: 1373-1381. e7.
 
12. Tapper EB, Ezaz G, Patwardhan V, et al. Hospital-level balloon tamponade use is associated with increased mortality for all patients presenting with acute variceal haemorrhage. Liver Int 2018;38:477-483.
 
13. Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2017;65:310-335.
 
14. Fogg T, Court L, Reid C. Critical care transport following balloon tamponade of variceal haemorrhage. Eur J Emerg Med 2013;20:144-145.
 
15. Lin AC, Hsu YH, Wang TL, et al. Placement confirmation of Sengstaken-Blakemore tube by ultrasound. Emerg Med J 2006;23:487.