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Am J Emerg Med. 2017 Oct;35(10):1500-1502. doi: 10.1016/j.ajem.2017.04.035. Epub 2017 Apr 20.

Outcomes in variceal hemorrhage following the use of a balloon tamponade device.

Author information

1
Department of Emergency Medicine, Cambridge Hospital, Cambridge, MA, USA.
2
Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
3
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
4
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
5
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, Division of Pulmonary Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
6
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Anesthesia Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: mcocchi@bidmc.harvard.edu.

Abstract

BACKGROUND:

Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD.

METHODS:

In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics.

RESULTS:

34 patients with a BTD were identified. Median age was 57.5 (IQR 47-63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p<0.01). One complication, an esophageal perforation, was identified and managed conservatively.

CONCLUSION:

In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy.

KEYWORDS:

Balloon tamponade device; Minnesota tube; Sengstaken-Blakemore; Tips; Transjugular intrahepatic portosystemic shunt; Variceal hemorrhage

PMID:
28460805
PMCID:
PMC5623073
DOI:
10.1016/j.ajem.2017.04.035
[Indexed for MEDLINE]
Free PMC Article

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