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The Sengstaken-Blackmore probe
Last reviewed: 06.07.2025

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Esophageal tamponade is used much less frequently with the advent of vasoactive drugs, esophageal vein sclerotherapy and TVPS. It is performed using a Sengstaken-Blakemore probe. The four-lumen probe has balloons for the esophagus and stomach; one of the lumens communicates with the stomach, and through the other, constant suction of the esophageal contents accumulating above the esophageal balloon is established.
Two or better three assistants are required for probing. It is easier to insert a probe frozen in ice or in a refrigerator, as it becomes more rigid. The stomach is emptied. The probe is checked and, after lubrication, passed through the mouth into the stomach. The gastric balloon is inflated with 250 ml of air and the tube is clamped with two clamps. The stomach contents are continuously aspirated. The probe is then pulled back if possible, after which the esophageal balloon is inflated to a pressure of 40 mm Hg, which certainly exceeds the pressure in the portal vein. The pulled-up probe is securely fixed to the face. If further tension is required, a bottle with 500 ml of saline solution is attached to the probe at the side of the bed. If the tension is too weak, the gastric balloon is lowered back into the stomach. Excessive tension causes an unpleasant sensation and vomiting, and also contributes to ulceration of the esophagus and stomach. The position of the probe is checked radiographically. The head end of the bed is raised.
The esophageal tube is attached to a system for continuous suction under low pressure, with occasional more vigorous aspiration of the esophageal contents. The tension of the tube and the pressure in the esophageal balloon should be checked every hour. After 12 hours, the tension is released and the esophageal balloon is deflated, leaving the gastric balloon inflated. If bleeding reoccurs, the tension is increased again and the esophageal balloon is inflated, followed by emergency sclerotherapy, TIPS, or surgery.
In general, tamponade with a probe is effective. There is no effect in 10% of cases, which is due to varicose veins of the fundus of the stomach or bleeding from another source. In 50% of cases, after removal of the probe, bleeding resumes.
Possible complications include upper airway obstruction. If the gastric balloon ruptures or deflates, the esophageal balloon may migrate into the oropharynx and cause asphyxia. In this case, the esophageal balloon should be deflated and, if necessary, the tube should be cut with scissors.
With prolonged or repeated use of the probe, ulceration of the mucous membrane of the lower esophagus is possible. Although the contents of the lumen of the esophagus are constantly aspirated, its aspiration into the lungs is observed in 10% of cases.
Tamponade with a Sengstaken-Blakemore tube is the most reliable method for long-term stopping of esophageal bleeding (for many hours). Complications develop frequently and partly depend on the experience of doctors. The procedure is unpleasant for the patient. The use of a Sengstaken-Blakemore tube is especially indicated when it is necessary to transport the patient from one clinic to another, massive bleeding, the absence of the possibility of emergency sclerotherapy of varicose veins, TIPS or surgical intervention. The esophageal balloon should not be kept inflated for more than 24 hours, and the optimal time for its presence in the esophagus is no more than 10 hours.