Sengstaken-Blackmore Probe

Tamponade of the esophagus with the appearance of vasoactive drugs, esophageal esophageal sclerotherapy and TSSH are used much less often. It is carried out using a Sengsteichen-Blakmore probe. In the four-lumen probe there are balloons for the esophagus and stomach; one of the lumens communicates with the stomach, the other adjusts the constant suction of the contents of the esophagus, accumulating above the esophageal balloon.

When probing, two, or better, three helpers are required. It is easier to install 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 is carried 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 contents of the stomach are constantly aspirated. The probe is then pulled back as far as possible, after which the esophageal balloon is inflated to a pressure of 40 mmHg, which is certainly higher than the pressure in the portal vein. A tight probe is securely fixed to the face. If you need to increase the tension even more, a bottle attached to the probe with 500 ml of saline is suspended from the side of the bed. If the tension is too low, the gastric balloon falls back into the stomach. Excessive tension causes an unpleasant sensation and vomiting, and also contributes to the ulceration of the esophagus and stomach. The position of the probe is monitored radiographically. The head end of the bed is raised.

The esophageal probe is attached to the system for constant suction under low pressure, and from time to time resorts to more vigorous aspiration of the contents of the esophagus. Every hour, the probe tension and pressure in the esophageal balloon should be checked. After 12 h, the tension is relaxed and the esophageal balloon is released, leaving the gastric balloon inflated. If the bleeding is resumed, the tension again reinforces and inflates the esophageal balloon; followed by recourse to emergency sclerotherapy, TSSH or surgical intervention.

In general, the tamponade with the probe is effective. The effect is absent in 10% of cases, which is caused by varicose veins of the bottom of the stomach or bleeding from another source. In 50% of cases after bleeding the probe the bleeding resumes.

Among the possible complications is obstruction of the upper respiratory tract. If the gastric balloon bursts or is blown off, the esophageal balloon can move into the oropharynx and cause asphyxia. In this case, the esophageal balloon should be blown off, and if necessary cut the probe with scissors.

With prolonged or repeated application of the probe, ulceration of the mucous membrane of the lower parts of the 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 the Sengsteiken-Blakemore probe is the most reliable method for prolonged stopping of esophageal bleeding (for many hours). Complications develop often and partly depend on the experience of doctors. The procedure is unpleasant for the patient. The use of the Sengsteichen-Blakemore probe is especially indicated when it is necessary to transport the patient from one clinic to another, massive bleeding, the lack of the possibility of emergency sclerotherapy of varicose veins, TSSH, or surgical intervention. Esophageal balloon should not be kept inflated for more than 24 hours, and the optimal time in the esophagus is no more than 10 hours.

[1], [2], [3], [4]