In 1950 Robert W. Sengstaken and Arthur H. Blakemore recognized that the introduction of blood banks and the ability to provide patients with large quantities of blood quickly was saving lives, especially in cases of hemorrhaging esophageal varices, but transfusion alone was not sufficient. Many patients who present with esophageal varices also have liver cirrhosis. Cirrhotic livers, in general, are more fragile to anoxia and shock. They found that transfusions were very beneficial in the initial presentation, but patients were often dying days later after admission due to liver failure. They examined recent advancements made in controlling peptic ulcers, which had dramatically reduced mortality rates. They formulated a method to halt varices related hemorrhage with the goals of decreasing total blood loss, end-organ shock, and delayed deaths. At the time, there was no device available for esophageal varices tamponade; however, in the previous decade, there was experimentation with portal pressure readings for portal hypertension patients. The portal pressure readings gave an idea of how much pressure was required to result in a collapse of the veins in the coronary-esophageal collateral circuit. From this information, they also derived the amount of pressure that the esophagus could withstand for an extended period of time.[1]

They subsequently developed the Sengstaken-Blakemore tube, which is rarely used but can be extremely useful in situations when first-line treatment fails. Endoscopy by a gastroenterologist is the gold standard for both diagnosing and treating an acute variceal hemorrhage. Endoscopic band ligation is the treatment of choice, but sclerotherapy is also used.[2] Unfortunately, even when practicing at a location with a readily available gastroenterologist, the endoscopic procedures are not always successful. In these scenarios, the balloon tamponade technique may be a lifesaving transitory measure to control the hemorrhage.[3]

Esophageal varices are most commonly the result of liver cirrhosis. As the hepatic tissue becomes scarred, the vasculature can become compressed and obstructed, leading to portal hypertension. Portal hypertension leads to increased pressure in the veins of the esophagus and stomach. The increased pressure results in the development of varices. Specifically, varices can develop in the para-esophageal collateral veins supplied from the azygos vein and short gastric veins supplied from the splenic vein.[4] 

Sengstaken-Blakemore tube placement is indicated for unstable patients with an uncontrolled hemorrhage. In some instances, endoscopy is not available; however, even if it is available, it is not always successful. In both scenarios, Sengstaken-Blakemore tube placements can temporarily control the hemorrhage.[5][6] Another indication would be if there is a lack of available consultants or specialist physicians, such as in remote rural areas. The tube can be placed to stabilize the patient for transfer to a facility with a higher level of care. As previously stated, in all situations, the Sengstaken-Blakemore tube is only a temporizing, rescue measure. Even if the initial hemorrhage is controlled by the balloon tamponade, over 50% of patients will rebleed when the device is deflated; therefore, a definitive treatment is always needed.[7]

The relative contraindications include known esophageal stricture and recent esophageal or gastric surgery. Both of these predispose the patient to an increased risk of esophageal rupture. However, Sengstaken-Blakemore tube placement is almost always a last resort option to control an unstable, massive hemorrhage. It is considered an emergent life-saving measure; therefore, the risks must be considered in that frame of reference.[8]

Please note that while equipment and technique of balloon tamponade devices for esophageal varices are similar, this list is specific to Sengstaken-Blakemore tube placement. The most common tube types are Sengstaken-Blakemore tube and the Minnesota tube, with the major difference being that the Minnesota tube has a larger gastric balloon and both gastric and esophageal aspiration ports. The Sengstaken-Blakemore tube only has an aspiration port for gastric contents; however, a double-lumen nasogastric tube used as an esophageal aspiration port. Further note that there are a few variations on the supplies required. It is possible to place the tube without Luer-locks and stopcocks by clamping the tubing with Magill forceps instead.[1]

• Blakemore
• Double lumen nasogastric tube
• 60 ml Luer-lock syringe
• 60 ml Slip-tip syringe
• 2 male Christmas tree Luer-lock converters
• 3 three-way stopcocks
• 3 Medlock caps
• Surgilube
• Manometer
• Roller-bandage
• 1 one-liter bag of intravenous fluids
• Optional: 2 Hollister ETAD (ET tube securing devices)
• Possibly: Laryngoscope, Magill Forceps