In the midst of torrential variceal bleeding, it is sometimes difficult to achieve hemostasis with band ligation, epinepherine use or sclerotherapy. For such cases, temporary tamponade is indicated. The use of a Blakemore tube provides the endoscopist a means for temporizing the bleeding until more definitive approach, such as TIPS, can be undertaken. We also learned today that the use of tamponade results in a prolonged hemostasis in nearly half of cases.
To be sure, complications may arise with the use of this device, so the endoscopist should be well-versed in proper use. Esophageal rupture can occur, either via pressure-necrosis if the balloon is left in-situ for more than 4 hours, or if the gastric balloon is inflated/ or pulled into the esophagus. Furthermore, there are reports of aspiration pneumonitis, and airway compromise.
Proper inflation volumes include gastric balloon 200 mmHg, and esophageal balloon 40 mmHg. A chest x ray should confirm gastric location after only 40 cc of air is injected into the gastric balloon; any more distention will put the esophagus at risk if placement is off. The equivalent of one liter of saline in a bag is sufficient traction for keeping the apparatus in place, and the tube itself should be affixed to the front of the football facemask. The esophageal balloon (which will only be inflated if there is failure to achieve hemostasis with gastric balloon alone) should be deflated for 15 minutes, every 4 hours.
For a video demonstration of tamponade, you may click on the link below. The video features a prominent transplant hepatologist from Yale New Haven Hospital: