Balloon tamponade in variceal bleeding: use and misuse.

Patients, methods, and results Over two years 30 patients were referred to this unit for the management of variceal bleeding with a balloon in position. Technical factors that we considered important for controlling bleeding were for the gastric balloon to be positioned close to the gastro-oesophageal junction and for it to be adequately inflated (in excess of 100 ml). Factors that we believed increased the risk of complications were: inflating the gastric balloon within the oesophagus (with the risk of oesophageal rupture); inadequately filling the gastric balloon (<100 ml allowed the tube to move upwards into the oesophagus, increasing the risk of occlusion of the larynx and pulmonary aspiration), inflating an oesophageal balloon at the level of the larynx; and using excessive mechanical traction (>1 kg) of the tube or applying inflation for prolonged periods (>36 hours). In only 13 of the 30 patients was balloon tamponade effectively used to control bleeding. Failure to position the balloon correctly (13 cases) was the most common fault. In 15 cases the tube was used in such a way that there was a high risk of complications. The most common problem was underinflation of the gastric balloon (eight cases). In five cases excessive or prolonged traction was applied to the tube and resulted in severe ulceration of the gastro-oesophageal junction. In one case the gastric balloon was inflated in the oesophagus, but without serious consequences. Balloon tamponade was considered to be optimumthat is, both effective and safe-in only 10 of the patients.