Outcomes in variceal hemorrhage following the use of a balloon tamponade device

• Published in: The American journal of emergency medicine 2017-10, Vol.35 (10), p.1500-1502
• Main Authors: Nadler, Jonathan, MD, Stankovic, Nikola, BS, Uber, Amy, BA, Holmberg, Mathias J., MD, Sanchez, Leon D., MD, MPH, Wolfe, Richard E., MD, Chase, Maureen, MD, MPH, Donnino, Michael W., MD, Cocchi, Michael N., MD
• Format: Article
• Language: English
• Subjects: Aged; Balloon Occlusion - methods; Balloon tamponade device; Emergency; Emergency medical care; Endoscopy; Endoscopy, Digestive System; Esophageal and Gastric Varices - diagnosis; Esophageal and Gastric Varices - mortality; Esophageal and Gastric Varices - therapy; Esophagus; Female; Follow-Up Studies; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - therapy; Hemorrhage; Hepatology; Humans; Hypertension; Male; Massachusetts - epidemiology; Medical prognosis; Medical records; Middle Aged; Minnesota tube; Morbidity; Multivariate analysis; Patients; Recurrence; Retrospective Studies; Sengstaken-Blakemore; Survival Rate - trends; Tamponade; Tips; Transjugular intrahepatic portosystemic shunt; Treatment Outcome; Variceal hemorrhage
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.04.035

Abstract Background Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. Methods In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. Results 34 patients with a BTD were identified. Median age was 57.5 (IQR 47–63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS ( p < 0.01). One complication, an esophageal perforation, was identified and managed conservatively. Conclusion In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy.