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


METHODS
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.
Dingguo
D
Zhang
Ruiyue
R
Shi
Jun
J
Yao
Ru
R
Zhang
Zhenglei
Z
Xu
Lisheng
L
Wang
D000328:Adult; D021721:Balloon Occlusion / Q000009:adverse effects / Q000295:instrumentation*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal; D004867:Equipment Design; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome