Outcomes of patients treated with Sengstaken-Blakemore tube for uncontrolled variceal hemorrhage

Abstract

Background/AimsThe aim of this study was to investigate the mortality, bleeding control rate, and their associated predictors in patients treated with Sengstaken-Blakemore (SB) tube for uncontrolled variceal hemorrhage associated with hemodynamic instability or failure of endoscopic treatment.MethodsThe clinical data of 66 consecutive patients with uncontrolled variceal hemorrhage treated with SB tube at Gyeongsang National University Hospital from October 2010 to October 2015 were retrospectively analyzed.ResultsThe overall success rate of initial hemostasis with SB tube was 75.8%, and the independent factors associated with hemostasis were non-intubated state before SB tube (odds ratio, 8.50; p = 0.007) and Child-Pugh score < 11 (odds ratio, 15.65; p = 0.022). Rebleeding rate after successful initial hemostasis with SB tube was 22.0%, and esophageal rupture occurred in 6.1%. Mortality within 30 days was 42.4%, and the related independent factors with mortality were failure of initial hemostasis with SB tube (hazard ratio, 6.24; p < 0.001) and endotracheal intubation before SB tube (hazard ratio, 2.81; p = 0.018).ConclusionsSince the era of endoscopic band ligation, SB tube might be a beneficial option as a temporary salvage treatment for uncontrolled variceal hemorrhage. However, rescue therapy had a high incidence of fatal complication and rebleeding.

Balloon Tamponade and Esophageal Stenting for Esophageal Variceal Bleeding in Cirrhosis: A Systematic Review and Meta-analysis

“…The two most recent studies explore the role of BT in patients with previous endoscopic therapy according to current guidelines. For this reason, in section "Balloon Tamponade" of this review, the results of the main outcomes of the balloon tamponade studies will remain mostly descriptive with the exception of the two most recent studies 28,29 which could be subject to meta-analysis.…”

“…Regarding the indication for "bridge" therapy, with the exception of the two most recent studies, 28,29 the vast majority of the patients who had BT placed were in the context of acute, severe/massive bleeding without a previous attempt of endoscopic therapy (n ¼ 489) or its combination with vasoactive drugs. On the contrary, the majority (87%) of patients in the stent studies had the stent placed for endoscopic-refractory bleeding (n ¼ 163/188).…”

Massive Hematochezia Secondary to Rectal Enema Injury: The Role of Sengstaken–Blakemore Tube for Hemostasis When Endoscopy Fails

“…The use of the Sengstaken-Blakemore tube in esophageal variceal bleeding is a temporizing, emergent rescue measure and risks associated with using mechanical compression to arrest hemorrhage must be evaluated within that frame of reference. The most common causes of death in patients treated with the Sengstaken-Blakemore tube for recalcitrant esophageal variceal bleeding are failure of hemostasis (42.9%), rebleeding (17.9%), and esophageal perforation (14.3%) [ 14 ]. As esophageal perforation is the only addressable cause of lethal complications, any conditions that increase the risk of perforation (esophageal or gastric surgery or esophageal strictures) are the only relative contraindications to the use of tamponade devices.…”

“…Furthermore, patients who require tamponade devices for managing variceal hemorrhage are, by definition, end-stage cirrhotics with high 30-day mortality rates (42.4%) after bleeding diatheses requiring the Sengstaken-Blakemore tube [ 14 ]. Therefore, when comparing patient cohorts that were treated with pressure tamponade for variceal versus LGIH, only limited conclusions regarding the limitations of this treatment modality in LGIH management can be drawn.…”

Tracheal injury characterized by subcutaneous emphysema and dyspnea after improper placement of a Sengstaken–Blakemore tube

“…The most common adverse events associated with the use of an SB tube include upper gastrointestinal mucosal injury, breathing difficulties, esophageal perforation, balloon leaks or ruptures, cardiac arrhythmias, and difficult extubation. [ 15 – 17 ] Until 1980, the effectiveness of the SB tube for hemostasis of variceal bleeding was reportedly 50% to 90%. [ 18 – 22 ] Today, the SB tube is only recommended for uncontrolled acute variceal bleeding as a bridge to definitive treatment, such as a transjugular intrahepatic portosystemic shunt (TIPS).…”