Tube Compression of the Esophagus and Stomach

Definition

Tube compression of the esophagus and stomach is an emergency procedure used to stop bleeding from the upper digestive tract.

Purpose

Vomiting blood is both frightening and life-threatening. Among its causes are:

• bleeding from the nose and throat
• peptic ulcers
• stomach cancer
• esophageal cancer
• a tear in the esophagus caused by violent vomiting (Mallory-Weiss syndrome)
• breaking of blood vessels in the esophagus

The most profuse bleeding comes from veins in the lower esophagus, just above the stomach, that have dilated to enormous dimensions as the result of liver disease. When the liver shrinks due to cirrhosis (scarring from chronic disease), its blood vessels shrink, forcing blood from the intestines to find alternate routes back to the heart. The blood usually flows through tiny veins in the esophagus located just beneath the passageway where food passes downward and vomitus passes upward. Major causes for this rearrangement are alcoholic liver disease, chronic hepatitis, and cholangiitis. Called esophageal varices, the affected veins can be easily damaged and bleed voraciously.

Description

One emergency method of stopping bleeding from esophageal varices is to tamponade it with a balloon. The Sengstaken-Blakemore tube is a complex rubber device with two balloons and three channels—one channel for each balloon and one that goes all the way through. The Minnesota tube has four channels, an extra one that opens above the first balloon. The bottom balloon is round; the upper balloon is long and narrow. The tube is passed through the nose or mouth into the stomach, where the bottom balloon is inflated. Then the tube is pulled back until the bottom balloon comes up against the narrow valve at the top of the stomach, when it can go no further. At this point, the upper balloon is inflated, putting pressure on a length of esophagus where the bleeding veins are located. The tube is then fixed so it cannot be dislodged. The third channel in the tube is used to aspirate (suck out) stomach contents to see if the bleeding has stopped. The fourth channel aspirates from the esophagus.

These tubes are a temporary measure. They stabilize the patient until bleeding has stopped, blood transfusions are received, and permanent repair is imminent.

Since the lower balloon effectively separates the esophagus from the stomach, it is possible to determine more accurately where the bleeding is located when it is in place.

This method of treating upper intestinal bleeding is being replaced by procedures that use a gastroscope, a flexible device that permits viewing and operating without surgery.

Preparation

The procedure is explained to the patient and family. A sedative may be given to prepare the patient for the procedure.

Aftercare

With the tube in place, the patient cannot eat and may have some difficulty breathing. The patient will be hospitalized until the tube can be removed.

Risks

Major complications frequently occur, and death results about 3% of the time. Problems include damage to the esophagus and stomach and interference with the airway. Should the tube remain in place too long, there is danger of the pressure eroding the esophagus or the nose.

BOOKS

Henneman, Philip L. "Gastrointestinal bleeding." In Emergency Medicine, ed. Peter Rosen, et al. St. Louis: Mosby, 1998.

J. Ricker Polsdorfer, MD

KEY TERMS

Cholangiitis—Inflammation of the system of tubes that drains bile from the liver into the intestines.

Chronic hepatitis—Long lasting inflammation of the liver due to viruses or other causes.

Peptic ulcers—Wounds in the stomach and duodenum caused by stomach acid and the bacterium Helicobacter pylori.

Tamponade—To occlude by pressure.