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SUMMARY To compare the efficacy of two oesophageal tamponade tubes, 28 patients with endoscopically proven actively bleeding varices were randomly allocated to be intubated with either a newly available 4-lumen tube incorporating an extra lumen for oesophageal suction, or the modified 3-lumen Sengstaken tube. The patients and the nursing staff preferred using the 4-lumen tube and both aspiration pneumonias and balloon dysfunction occurred less frequently. Variceal haemorrhage was successfully controlled for the first 12 hours in most patients in the two treatment groups, although the incidence of re-bleeding at 48 hours after the tube had been deflated was high.Variceal haemorrhage is a life-threatening problem in patients with portal hypertension, and, despite the absence of controlled data, most clinicians would consider that oesophageal tamponade with the Sengstaken-Blakemore tube remains the most reliable non-surgical means of immediately controlling the bleeding.12 While oesophageal ulceration and pulmonary aspiration of gastric contents and saliva are serious complications of oesophageal tamponade,3 they can be minimised by limiting the duration of tamponade to approximately 24 hours,4 by avoiding traction and by adding a fourth lumen for continuous pharyngeal suction.5 Our experience, however, has shown that such complications still occur despite these safety measures and the close supervision by trained staff in a specialist unit. Recently a new oesophagogastric tamponade tube has become available to aid aspiration of pharyngeal collections of fluid and in this paper we report the results of a prospective trial designed to compare the efficacy of this tube with that of the modified 3-lumen Sengstaken tube previously used. Particular emphasis has been placed upon comparing ease of intubation, patient tolerance, and problems of tube management.

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