Initial control of bleeding from esophageal varices with the Sengstaken-Blakemore tube. Experience in 82 patients.

The records of 82 patients treated with the Sengstaken-Blakemore tube for massive bleeding from esophageal varices have been reviewed. Initial control of hemorrhage was obtained in 78 patients (95 percent). Six patients suffered major nonfatal complications, including bronchial aspiration (five patients) and esophageal rupture (one patient). Twenty-one patients rebled after balloon deflation and underwent emergency portal disconnection of the esophagus with a clip. The other patients underwent elective operation. Long-term survival rates were 49 percent at 1 year, 35 percent at 5 years, and 14 percent at 10 years. Ninety-four percent of the patients were free of recurrent variceal bleeding, as proved by endoscopy, at 1 year, 90 percent at 5 years, and 77 percent at 10 years. This study shows that temporary use of the Sengstaken-Blakemore tube for the initial control of acutely bleeding esophageal varices is effective and relatively safe. In our experience, methods for the prevention of complications were early endotracheal intubation in patients under anesthesia, avoidance of traction on the tube, and a period of tamponade not exceeding 24 hours.