What is a Blakemore tube (Sengstaken-Blakemore tube) and how is it used to manage Gastrointestinal (GI) bleeding?

From the Guidelines

A Blakemore tube, also known as a Sengstaken-Blakemore tube, is used to manage severe upper gastrointestinal bleeding from gastric varices by inflating the gastric balloon and anchoring it against the gastroesophageal junction, as recommended by the American Association for the Study of Liver Diseases in 2017 1. To use a Blakemore tube, the following steps should be taken:

• Confirm the diagnosis of variceal bleeding and ensure the patient has adequate airway protection, ideally with endotracheal intubation.
• Insert the tube through the nose or mouth into the stomach, and confirm its position by aspirating gastric contents or by X-ray.
• Inflate the gastric balloon with 250-500 mL of air or saline, then apply gentle traction to pull the balloon against the gastroesophageal junction, as suggested by the 2017 practice guidance 1.
• If bleeding continues, consider inflating the esophageal balloon, but this should be done with caution and careful monitoring of balloon pressures.
• The tube should remain in place for no more than 24-48 hours due to the risk of pressure necrosis, and balloon pressures should be checked every 4 hours.
• Continuous suction should be applied to the gastric and esophageal ports to monitor ongoing bleeding. This is a temporary measure until definitive therapy, such as endoscopic band ligation, sclerotherapy, or TIPS procedure, can be performed, as outlined in the 2017 guidance by the American Association for the Study of Liver Diseases 1. Key considerations when using a Blakemore tube include:
• Airway protection to prevent aspiration
• Risk of esophageal rupture, mucosal ulceration, and airway obstruction
• Need for careful monitoring of balloon pressures and ongoing bleeding
• Importance of removing the tube as soon as possible to minimize complications, as recommended by the 2017 practice guidance 1.

From the Research

Definition and Purpose of the Blakemore Tube (Sengstaken-Blakemore Tube)

• The Blakemore tube, also known as the Sengstaken-Blakemore tube, is a medical device used to manage gastrointestinal (GI) bleeding, particularly in cases of severe bleeding that are unresponsive to other treatments 2, 3.
• The tube is designed to apply pressure to the bleeding site through balloon tamponade, which helps to control the bleeding and stabilize the patient.

Indications for Use

• The Sengstaken-Blakemore tube is typically used in hemodynamically unstable patients with massive GI bleeding who are unable to undergo endoscopy, have failed endoscopy, or require stabilization before transfer to another facility 2.
• It can also be used as a rescue treatment for hemorrhagic shock secondary to laparoscopic adjustable gastric banding erosion 3.
• Additionally, the tube may be used to manage acute lower GI bleeding when other methods have been unsuccessful 4, 5.

Placement and Technique

• The Sengstaken-Blakemore tube can be placed using various techniques, including endoscopic placement, which allows for accurate and easy placement of the tube 6.
• The tube is typically inserted through the nose or mouth and guided into the stomach, where the gastric balloon is inflated to apply pressure to the bleeding site.
• In some cases, the tube may be inserted per rectum to manage lower GI bleeding, as described in a case report where a Sengstaken-Blakemore tube was used to control massive rectal bleeding 5.

Types of Balloon Tamponade Devices

• There are several types of balloon tamponade devices available, including the Linton-Nachlas tube, the Sengstaken-Blakemore tube, and the Minnesota tube, each with unique features such as the number of balloons and ports 2.
• The choice of device depends on the specific clinical scenario and the patient's needs.