title: Surviving Sengstaken.
abstract: OBJECTIVE
  To report the outcomes of children who underwent Sengstaken-Blakemore tube (SBT) insertion for life-threatening haemetemesis.
  
  
  METHODS
  Single institution retrospective review (1997-2012) of children managed with SBT insertion. Patient demographics, diagnosis and outcomes were noted. Data are expressed as median (range).
  
  
  RESULTS
  19 children [10 male, age 1 (0.4-16) yr] were identified; 18 had gastro-oesophageal varices and 1 aorto-oesophageal fistula. Varices were secondary to: biliary atresia (n=8), portal vein thrombosis (n=5), alpha-1-anti-trypsin deficiency (n=1), cystic fibrosis (n=1), intrahepatic cholestasis (n=1), sclerosing cholangitis (n=1) and nodular hyperplasia with arterio-portal shunt (n=1). Three children deteriorated rapidly and did not survive to have post-SBT endoscopy. The child with an aortooesophageal fistula underwent aortic stent insertion and subsequently oesophageal replacement. Complications included gastric mucosal ulceration (n=3, 16%), pressure necrosis at lips and cheeks (n=6, 31%) and SBT dislodgment (n=1, 6%). Six (31%) children died. The remaining 13 have been followed up for 62 (2-165) months; five required liver transplantation, two underwent a mesocaval shunt procedure and 6 have completed endoscopic variceal obliteration and are under surveillance.
  
  
  CONCLUSIONS
  SBT can be an effective, albeit temporary, life-saving manoeuvre in children with catastrophic haematemesis.
authors.affiliation: Department of Paediatric Surgery, Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS.
authors.forename: S
authors.initials: S
authors.lastname: Jayakumar
authors.affiliation: Department of Paediatric Surgery, Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS.
authors.forename: A
authors.initials: A
authors.lastname: Odulaja
authors.affiliation: Department of Paediatric Surgery, Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS.
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Paediatric Surgery, Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS.
authors.forename: M
authors.initials: M
authors.lastname: Davenport
authors.affiliation: Department of Paediatric Surgery, Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS. Electronic address: niyi.adeajayi@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Ade-Ajayi
mesh_terms: D000293:Adolescent; D001018:Aortic Diseases / Q000209:etiology / Q000601:surgery; D001656:Biliary Atresia / Q000150:complications / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications; D004724:Endoscopy; D004937:Esophageal Fistula / Q000601:surgery; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D011169:Portal Vein; D011170:Portasystemic Shunt, Surgical; D012189:Retrospective Studies; D015607:Stents; D016157:Vascular Fistula / Q000209:etiology / Q000601:surgery; D020246:Venous Thrombosis / Q000150:complications / Q000601:surgery; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications
keywords: Balloon tamponade; Haemetemesis; Oesophageal varices; Portal hypertension; Sengstaken–Blakemore tube