Esophageal tamponade in the treatment of bleeding varices. A decadel progress report

Abstract

Previous reports from this hospital in 1958 and 1967 have revealed that esophageal tamponade is a relatively dangerous type of treatment. Other investigators have been able to avoid many of the hazards of this technique. We have again assessed our results in 50 episodes of esophageal tamponade in bleeding esophageal varices in 39 patinets. Thirty-seven had alcoholic cirrhosis, one Wilson's disease, and one portal vein thrombosis. The diagnosis of variceal hemorrhage was established by endoscopy or angiography in virtually all. The great majority (86%) had had unsuccessful infusions of vasopressin previously. The Sengstaken-Blakemore tube (SBT) was used in 41 and the Linton tube (LT) in nine. Hemorrhage was controlled for at least 24 consecutive hours in 20 episodes (40%). Ninety percent of the patients died. Rupture of the esophagus following inflation of the gastric balloon in the esophagus caused three deaths (8%). Major nonfatal complications such as aspiration pneumonia occurred on five other occasions. Although the complications of esophageal tamponade were greatly reduced from our previous series, the efficacy of esophageal tamponade also decreased. There were no significant differences in the efficacy or complications of the SBT and LT. The high mortality and complication rates are still discouraging. We believe that the role of esophageal tamponade in the treatment of hemorrhage from varices is a secondary one.