The Sengstaken-Blakemore Tube and its use


The Sengstaken-Blakemore tube is one of those medical devices that you hope you never need to have placed in you. The tube is used in emergency situations to stop bleeding of the esophagus, that is, the tube that connects your mouth to your stomach. In general, successful use of a Sengstaken-Blakemore tube is a life saving procedure and is virtually always done as a bridge to more definitive life-saving therapy.

The Sengstaken-Blakemore tube is a long, thin rubber hose that has two different inflatable balloons. The tube is placed through the nose (usual) or mouth, down the esophagus until one end resides in the stomach. Once a sufficient length of tube is in the stomach, the first or stomach balloon is inflated. When inflated, this balloon prevents the tube from being pulled out of the esophagus—it holds the Sengstaken-Blakemore tube in place. The second balloon is then inflated inside of the esophagus itself. The inflated balloon puts pressure on the walls of the esophagus and, like applying direct pressure on a bleeding wound, the bleeding regions of esophagus are squeezed shut in a process known as tamponade. Under ideal circumstances, the Sengstaken-Blakemore tube provides enough esophageal tamponade to halt or significantly slow bleeding until another, more definitive intervention can be performed.

There are only a few reasons why your esophagus would bleed to the point of requiring a Sengstaken-Blakemore tube, but the most common indication for this use of this special tube is bleeding esophageal varices. Esophageal varices are blood vessels that are very near to or penetrate into the lining of the esophagus. These blood vessels have very thin walls and, as such, can rupture with very little trauma. People with chronic liver disease are particularly susceptible to the formation of these distended blood vessels.

The original Sengstaken-Blakemore tube has changed very little over the past 60 years when it was first designed by, you guessed it, Dr. Sengstaken and Dr. Blakemore. As rubbers and plastics have improved, the device has received some upgrades, but the basic concept remains the same. The one major innovation to the Sengstaken-Blakemore tube was to make the dilating balloon smaller and of increased rigidity. This newer device is called the Linton-Nachlas tube and has been shown to be superior to the Sengstaken-Blakemore tube for stopping bleeding from gastric varices (blood vessels that have distended and invaded the stomach).

The emergent and life-threatening nature of bleeding esophageal varices often demands swift action on the part of emergency room physicians. As was mentioned, the Sengstaken-Blakemore tube is often used as a bridge to other therapies. One such therapy is rapid hydration or the administration of a blood transfusion to counteract blood loss. Since the blood from ruptured esophageal varices enters the stomach, if it is not suctioned out, the patient may vomit violently and forcefully dislodge the Sengstaken-Blakemore tube. Once the Sengstaken-Blakemore tube has successfully slowed bleeding and the patient has stabilized (at least somewhat) the varices can be clipped surgically to prevent further bleeding. If bleeding has stopped considerably, the bleeding may be stopped endoscopically but, more often, laparoscopic or open surgery is required.

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