Sengstaken-Blakemore Tube

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. 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. 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.