Treatment of massive esophageal variceal bleeding by Sengstaken-Blackmore tube compression and intensive endoscopic detachable mini- loop ligation: a retrospective study in 83 patients.

Abstract

Background/aims: To evaluate the effectiveness of improved sengstaken-blackmore tube combined with intensive endoscopic detachable mini-loop ligation for the treatment of massive esophageal variceal bleeding (EVB).

Methodology: Eighty-three patients diagnosed with massive EVB and admitted from January 2005 to July 2011 were retrospectively evaluated. Upon admission, all patients received 12 h balloon tamponade with sengstaken-blackmore tube in addition to conventional therapy (blood volume resuscitation, prophylactic antibiotics and somatostatin). Within 24 h after admission, all patients further received endoscopic variceal ligation (EVL) with intensive endoscopic detachable nylon ring (mini-loop).

Results: No severe complications were observed after the patients received the 12 h consistent compression with sengstaken-blackmore tube. Eighty-two patients (98.8%) showed effective hemostasis, among which seventy-eight showed complete hemostasis. After receiving the subsequent EVL therapy with intensive endoscopic detachable mini-loop in 24 h after admission, patients did not show active bleeding in 24 h after EVL. Rehaemorrhagia appeared only in one patient within the 7 days of observation period, which was controlled by a second EVL. Each patient was ligated with 10 to 15 loops.

Conclusions: EVB can be effectively treated with improved sengstaken-blackmore tube followed by EVL therapy with intensive endoscopic detachable mini-loop.