Balloon tamponade

Balloon tamponade involves the application of direct pressure to the area of bleeding with an inflatable balloon attached to a nasogastric tube. It is an option for patients in whom drug therapy and band ligation fail to stop variceal bleeding. Balloon tamponade is used only when other methods have failed. Once the direct pressure of the balloon is removed, rebleeding often occurs, so balloon tamponade is only a temporary measure prior to more definitive treatment such as shunting.11... 

If standard therapy fails to control bleeding, a salvage procedure such as balloon tamponade (with a Sengstaken-Blakemore tube), transjugular intrahepatic portosystemic shunt, or surgical shunting is necessary. 

If acute sclerosing is not possible or has failed due to massive haemorrhaging, the balloon tamponade may be used to provide temporary relief until the circulation has stabilized sufficiently, (s. p. 358) However, this is only effective (about 80%) for a limited period of time. Adjuvant medicinal therapy to reduce portal pressure is helpful, (s. p. 360) At this stage, elective sclerosing can generally be performed with better visibility and circulatory conditions. In approx. 70% of cases, primary haemostasis can be achieved by means of acute or elective sclerosing. It is seldom necessary to perform portal vein surgery. (58, 61, 65, 83, 90, 91, 94, 96, 97, 103, 104, 106, 115, 123, 130, 139, 143, 157, 163, 164, 190, 192, 194, 199, 200, 201, 204-207, 209, 210, 214, 216, 217, 221)... 

For primary haemostasis, sclerotherapy or varix ligation are considered to be the methods of choice. Should sclerotherapy or ligation not be feasible (as yet) for primary haemostasis, medication therapy (first priority) with terlipressin and octreotide may be applied as an alternative - with the aim of carrying out subsequent sclerosing or ligation as soon as possible. Should it be imperative to control massive bleeding without delay, the balloon tamponade method can be applied for a limited period of time. Here, too, the aim must be early sclerotherapy or ligation. 

Repeated sclerotherapy / banding ligation Drug therapy Balloon tamponade (if necessary)... 

Fort, E., Sauterean, D., Silvain, Ch., Ingrand, R, PiU and, B., Beanch-ant, M. A randomized trial of terlipressin plus nitroglycerin vs. balloon tamponade in the control of acute variceal hemorrhage. Hepatology 1990 11 678 -681... 

Jaramillo, J.L., de la Mata, M., Mino, G., Costan, G., Gomez-Cama-cho, F. Somatostatin versus Sengstaken balloon tamponade for primary haemostasia of bleeding esophageal varices. J. Hepatol. 1991 12 100-105... 

Panes, X, Teres, X, Bosch, X, Rodes, X Efficacy of balloon tamponade in treatment of bleeding gastric and esophageal varices results in 151 consecutive episodes. Dig. Dis. Sci. 1988 33 454—459... 

Paquet, K.-X, Feussner, H. Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices a prospective controlled randomized trial. Hepatology 1985 5 580-583... 

Cooper SG, Sofocleous CT (1998) Percutaneous management of angioplasty-related iliac artery rupture with preservation of luminal patency by prolonged balloon tamponade. J Vase Interv Radiol 9 81-83... 

Although rare, dissection or perforation of the renal arteries and their branches can occur. Rupture may lead to rapid development of retroperitoneal hemorrhage. Both dissection flaps and rupture can be immediately controlled with balloon tamponade. Although dissection flaps can often be tacked down, rupture typically requires emergent surgery. Even perforation of smaller branch vessels can occur if a guidewire is passed too far into the periphery. Hematoma and abscess can develop. 

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