Surviving Sengstaken

Jayakumar, S.; Odulaja, A.; Patel, S.; Davenport, Mark; Ade-Ajayi, N.

doi:10.1016/j.jpedsurg.2014.12.014

Cited by 15 publications

(4 citation statements)

References 33 publications

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“…In children with biliary atresia, spontaneous bleeding from gastroesophageal varices carries a risk of death, sometimes requires emergency liver transplantation or results in severe morbidity (9,13,16,(26)(27)(28)(29)(30)(31)(32)(33). Detection of HRVs before spontaneous bleeding has become a key element in the management of this population.…”

Section: Discussionmentioning

confidence: 99%

A Model for Early Endoscopic Detection of High‐Risk Gastroesophageal Varices in Children With Biliary Atresia

Ackermann

Boissieu²,

Bernard

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objective:In children with biliary atresia and portal hypertension, progression to gastroesophageal varices carrying a risk of bleeding depends on age, total serum bilirubin concentration and initial endoscopic features. We report an attempt to use these factors for early detection of high-risk varices (HRVs).Methods:Based on different combinations of these factors, a model was set to estimate the probabilities of emergence of HRVs at various time intervals. A 10% probability was chosen to set the date of the next endoscopy in children who did not display HRVs initially. A total of 113 children without HRVs who underwent their first endoscopy before age 8 in 2013–2020 were included. A comparison was made with children seen during the period 1990–2012 when this model was not used.Results:In all, 65 of the 113 children underwent one to five additional endoscopies at dates set according to the model. The emergence of HRVs was recorded in 22 children after a mean interval of 14 months and was managed by endoscopic primary prophylaxis in all but one who underwent liver transplantation. Three other children bled before the next planned endoscopy. Compared with 175 children of the same age ranges without HRVs in the period 1990–2012, the use of the model was associated with a faster detection of HRVs with a lower number of endoscopic procedures (P = 0.0022 and P = 0.023, respectively).Conclusion:The results suggest that the model reported may be a useful tool for the early detection of HRVs to allow primary prophylaxis of bleeding.

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Section: Discussionmentioning

confidence: 99%

A Model for Early Endoscopic Detection of High‐Risk Gastroesophageal Varices in Children With Biliary Atresia

Ackermann

Boissieu²,

Bernard

et al. 2021

J. pediatr. gastroenterol. nutr.

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“…Thoracotomy and fistula ligation was the definite treatment for the fistula. An esophageal tear was noted at the site of the SBT due to the larger size of the F18 tube rather than a more suitable size of F14–F16, as used in other cases [12].…”

Section: Discussionmentioning

confidence: 99%

Sengstaken-Blakemore Tube

Lawati

Brashdi

Rahbi

et al. 2017

International Journal of Pediatrics and Adolescent Medicine

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Upper gastrointestinal bleeding (UGIB) in children has multiple etiologies but fortunately is not encountered commonly by pediatricians. Aorto-esophageal fistula (AEF) in children is a rare cause of UGIB and it is mainly secondary to accidental ingestion of foreign bodies, particularly disc batteries, or after cardiothoracic surgery. In this study, we report a case of a 3-year-old child who developed de novo AEF with no prior injury to the esophagus. The child presented with massive UGIB leading to hypovolemic shock, acute kidney injury, and cardiac arrest. The torrential bleed was controlled using a Sengstaken–Blakemore Tube (SBT), which allowed urgent chest CT angiography as well as subsequent thoracotomy and repair of the fistula Unfortunately, the child succumbed to repeated cardiac arrests secondary to the renal injury and severe acidosis. This case highlights the need for the early recognition of massive UGIB in children and the requirement to make appropriately sized SBTs available in all pediatric gastroenterology units.

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“…Sengstaken-Blakemore tubes can be an effective, albeit temporary, life-saving manoeuvre in children with catastrophic haematemesis in those with known variceal bleeding while awaiting endoscopy (24).…”

Section: Pre-endoscopic Interventionmentioning

confidence: 99%

“…Prothrombin complex concentrate should be offered to patients who are taking warfarin and actively bleeding. Recombinant factor Vlla can be used only when all other methods have failed (24).…”

Section: Practical Managementmentioning

confidence: 99%

There Is No Excuse for Mortality Due to Lack of Competency and Training of Paediatric Endoscopists in Gastrointestinal Bleeding Therapy in 2018

Thomson¹

2018

J. pediatr. gastroenterol. nutr.

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Acute upper gastrointestinal bleeding in children is possibly the last medical emergency which continues to lead to the death of a child due to the lack of competency/clinical judgement of the doctor, as opposed to the disease itself, leading to mortality despite optimum medical intervention. This is unacceptable in any circumstances in 2018. It occurs due to a number of conspiring factors including lack of appreciation of the clinical presentation requiring urgent endoscopic intervention; misapprehension of the urgency of timing required of such an intervention predicated on the severity of the gastrointestinal (GI) bleed; lack of application of a paediatric-specific validated score predicting for such endoscopic intervention; lack of skill in endo-haemostatic intervention techniques by paediatric endoscopists; poor training in such techniques among paediatric endoscopists; paucity of cases with lack of exposure of the paediatric endoscopist regularly to enable skills to be maintained, once acquired; reluctance of adult endoscopists in many centres to support paediatric GI bleeding services. In essence then the paediatric GI community urgently needs to identify centres of excellence to whom these children should be transferred. Transfer is safe in all but the most critical cases once stabilised with transfusion, octreotide/terlipressin and iv proton pump inhibitors. The resources are country-dependent but this is really no excuse. We must not let this parlous state of affairs continue. Solutions are explored in this article and please let this serve as a call to action for all those involved in this continuing debacle in order to save “save-able” lives.

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Surviving Sengstaken

Abstract: SBT can be an effective, albeit temporary, life-saving manoeuvre in children with catastrophic haematemesis.

Cited by 15 publications

References 33 publications

A Model for Early Endoscopic Detection of High‐Risk Gastroesophageal Varices in Children With Biliary Atresia

A Model for Early Endoscopic Detection of High‐Risk Gastroesophageal Varices in Children With Biliary Atresia

Sengstaken-Blakemore Tube

There Is No Excuse for Mortality Due to Lack of Competency and Training of Paediatric Endoscopists in Gastrointestinal Bleeding Therapy in 2018

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