Oesophagus, dilatator by  SENGSTAKEN-BLAKEMORE

Oesophagus, dilatator, about 1950 



Patients with cirrhosis of the liver are interned patients for years, so even in case of emergency, they primarily turn to their internists: they even come to the Internist Outpatient Clinic, even with massive bleeding from esophageal varices (a classic result of liver cirrhosis), and the first measures have to be taken by internists.

The initial supply of esophageal variceal bleeding involves filling the circulation, followed in a hurry
 - An electro-coagulation of the source of bleeding. In case of failure
- Tamonade of bleeding varices by means of balloon catheter. For years the Tampnade with the so-called SENGSTAKEN BLAKEMORE probe has proven itself in the clinic.

Robert William SENGSTAKEN, American neurosurgeon (* 1923)
Arthur H. BLAKEMORE, American Surgeon (1897-1970).

The Sengstaken-Blakemore Probe is a three-lumen probe that is used in the most massive bleeding of esophageal varices. The lumens are on the one hand for the stomach and the esophageal balloon and others as a gastric tube with lateral openings in the stomach. The length for adults is 100cm, the maximum filling volume of the gastric balloon is 250ml and that of the esophageal balloon 150ml.
- The small round balloon is advanced into the stomach, expanded and then pulled forward until it lies distally to the cardia. Then the oblong esophageal balloon is inflated to compress the bleeding. To prevent pressure necrosis of the esophageal mucosa, however, this probe may only remain for a few hours under maximum pressure (35-45 mmHg), then the blood clotting must be corrected - the probe is carefully unblocked ... Some authors even recommend the oesophageal balloon not to inflate, to prevent rupture of the esophagus. So first fill the gastric balloon and pull it firmly up so that it blocks the venous blood flow from the stomach into the esophagus. Only in case of failure of this compression, the esophageal compression is indicated.

Recently, the probe is also recommended for massive obstetric bleeding:
- M. Kastesmark, R. Brown, KS. Raju, Successful use of a Sengstaken-Blakemore tube to control massive postpartum haemorrhage. British Journal of Obstetrics and Gynecology, March 1994, vol.101.pp259-260.
- D. Frenzel, G.S. Condous, A.T. Papageorghiou, N.A. McWhinney, The use of the 'tamponade test' to stop massive obstetric haemorrhage in placenta accreta, BJOG: An International Journal of Obstetrics & Gynecology, Volume 112 Issue 5 Page 676 - May 2005.