Esophageal varices occur as a consequence of portal hypertension and may develop in up to 50% of patients with cirrhosis, but prevalence varies according to severity of underlying liver disease. Rate of variceal bleeding is dependent on severity of liver disease, size of varices, and presence of high-risk stigmata on endoscopy that is indicative of areas of thinning of the variceal wall. Approximately one-third of patients with varices will experience variceal bleeding with an annual rate of 10% to 15% per year.¹,² Urgent endoscopic therapy is used as first-line therapy in treating acute variceal bleeding. Endoscopy band ligation is the primary treatment modality. In patients whose bleeding cannot be controlled by endoscopic therapy, emergent therapies via intervention radiology such as transjugular intrahepatic portosystemic shunt (TIPS) should be considered.¹,³ Balloon tamponade plays a role in management of variceal bleeding among patients in whom endoscopic therapy was unsuccessful in controlling bleeding and are in need of a “bridge” therapy in order to acutely stabilize active bleeding until further more definitive intervention can be performed.

The two most commonly used balloon tamponade systems are the Minnesota four-lumen esophagogastric tamponade tube and the three-lumen Sengstaken-Blakemore tube. The Minnesota tube incorporates an internal separate esophageal suction port in addition to the gastric suction port, gastric balloon inflation port, and esophageal balloon inflation port (Fig. 40.1). This esophageal suction port was added in order to help prevent aspiration of esophageal contents. When inflated, the balloons place pressure to decrease blood flow and thus help reduce active bleeding.