Balloon tamponade is used if sclerotherapy and vasoconstrictor therapy fail to control variceal bleeding or are contra-indicated. The usual tube is a Sengstaken- Blakemore which is passed into the stomach. The gastric balloon is inflated; the oesophageal balloon is inflated only if bleeding is not controlled by the gastric balloon. The technique is successful in 90% of cases. Serious complications, with a 5% mortality, include aspiration pneumonia, oesophageal rupture and mucosal ulceration. It is very unpleasant for the patient.
If gastric varices are the source of haemorrhage then a Linton-Nachlas tube (a tube with a single large balloon) is more effective in stopping haemorrhage.
Note that balloon tamponade is a temporary measure and it may cause pressure necrosis after 48-72 hours. Thus sclerotherapy or some other means of control should be used after 12-24 hours.
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