Surviving Sengstaken

Aim of the StudyTo report the outcomes of children who underwent Sengstaken–Blakemore tube (SBT) insertion for life-threatening haemetemesis.MethodsSingle institution retrospective review (1997–2012) of children managed with SBT insertion. Patient demographics, diagnosis and outcomes were noted. Data are expressed as median (range).Main Results19 children [10 male, age 1 (0.4–16) yr] were identified; 18 had gastro-oesophageal varices and 1 aorto-oesophageal fistula. Varices were secondary to: biliary atresia (n = 8), portal vein thrombosis (n = 5), alpha-1-anti-trypsin deficiency (n = 1), cystic fibrosis (n = 1), intrahepatic cholestasis (n = 1), sclerosing cholangitis (n = 1) and nodular hyperplasia with arterio-portal shunt (n = 1). Three children deteriorated rapidly and did not survive to have post-SBT endoscopy. The child with an aortooesophageal fistula underwent aortic stent insertion and subsequently oesophageal replacement. Complications included gastric mucosal ulceration (n = 3, 16%), pressure necrosis at lips and cheeks (n = 6, 31%) and SBT dislodgment (n = 1, 6%). Six (31%) children died. The remaining 13 have been followed up for 62 (2–165) months; five required liver transplantation, two underwent a mesocaval shunt procedure and 6 have completed endoscopic variceal obliteration and are under surveillance.ConclusionsSBT can be an effective, albeit temporary, life-saving manoeuvre in children with catastrophic haematemesis.