[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical skills](https://durgical.com/en/clinical-skills/) › [Vascular access](https://durgical.com/en/clinical-skills/areas/vascular/) › Balloon tamponade for bleeding varices

# Balloon tamponade for bleeding varices

- Procedure

A tube with balloons is passed into the stomach and inflated to press on bleeding veins until definitive treatment is possible.

Updated Nov 13, 2026

## Key points

- A bridge, not a cure: used for uncontrolled variceal bleeding until band ligation or TIPS; bleeding often returns after deflation.
- Secure the airway (intubate) before inserting the tube.
- Confirm the gastric balloon is in the stomach (X-ray) before full inflation: inflating it in the oesophagus can rupture it.
- Gastric balloon first with gentle traction; the oesophageal balloon only if bleeding continues, at a measured pressure.
- Keep scissors at the bedside: if the balloon migrates and blocks the airway, cut the tube to deflate it at once.

On this page

- The basics Key points
- What it is
- Indications
- Equipment
- Step by step (and why)
- The tubes and their channels
- Next step
- Elsewhere in DurgiPedia

- Clinical Complications

- Safety Contraindications and precautions

- Study Test yourself

- Connections Connections

## What it is

Balloon tamponade is a temporary rescue for massive bleeding from oesophageal or gastric varices that cannot be controlled by drugs and endoscopy, or when endoscopy is not available. The Sengstaken–Blakemore tube has three channels: a gastric balloon, an oesophageal balloon and a gastric aspiration port; the Minnesota tube adds an oesophageal aspiration port above the balloon, and the Linton–Nachlas tube has a single large gastric balloon for gastric varices. Most bleeding stops with the gastric balloon alone, inflated in the stomach and pulled up against the gastro-oesophageal junction, which compresses the inflow to the varices; the oesophageal balloon is inflated, with a manometer, only if bleeding continues. Tamponade controls bleeding in most patients, but bleeding returns in many when the balloons go down, so it is only a bridge, kept for no more than about a day, to endoscopic band ligation or a transjugular intrahepatic portosystemic shunt (TIPS). Because the patient is usually vomiting blood and drowsy, the airway is secured with intubation first. Vasoactive drugs, antibiotic prophylaxis and careful transfusion continue alongside.

## Indications

- Massive oesophageal or gastric variceal bleeding not controlled by vasoactive drugs and endoscopic therapy.
- Haemodynamic instability from variceal bleeding when endoscopy is not available or is delayed.
- Bridge to transfer, repeat endoscopy or TIPS.
- Bleeding that recurs early after endoscopic treatment while definitive therapy is arranged.

## Contraindications and precautions

- Airway not protected: intubate first; aspiration is a leading cause of death.
- Recent oesophageal or gastric surgery, or a known oesophageal stricture: risk of perforation.
- Bleeding source not likely variceal: tamponade does not help ulcers or tears, and may harm.
- Prolonged inflation of the oesophageal balloon causes ischaemia and necrosis: limit the time and deflate as protocol sets.
- Requires an experienced team and an intensive-care setting with continuous observation.

## Equipment

- Sengstaken–Blakemore, Minnesota or Linton–Nachlas tube, checked for leaks before use.
- Syringe for air, clamps and a manometer for the oesophageal balloon pressure.
- Water-soluble lubricant, suction and a nasogastric tube if the tube has no oesophageal port.
- Traction system or fixation as the unit protocol sets, and scissors kept at the bedside.
- Equipment for intubation and a portable X-ray.

## Step by step (and why)

- Intubate and start vasoactive drugs, antibiotics and transfusion — airway and circulation come before the tube.
- Test both balloons for leaks under water, then deflate fully — a leaking balloon fails when it is needed.
- Lubricate and pass the tube through the mouth well into the stomach — insertion too short leaves the balloon in the oesophagus.
- Aspirate the gastric port and inflate the gastric balloon with a little air, then X-ray — it proves the balloon is below the diaphragm.
- Complete gastric inflation as the device specifies and clamp it — a full balloon anchors at the junction.
- Pull back gently until resistance and apply steady traction — the balloon presses on the inflow to the varices.
- If bleeding continues, inflate the oesophageal balloon to the target pressure on a manometer — measured pressure limits necrosis.
- Mark the tube at the mouth, aspirate both ports regularly — a moved mark warns of migration; aspirate shows rebleeding.
- Plan release within about a day and arrange endoscopy or TIPS — the balloon only buys time.

## The tubes and their channels

| Tube | Channels | Notes |
| --- | --- | --- |
| Sengstaken–Blakemore | Gastric balloon, oesophageal balloon, gastric aspiration | Needs a separate tube above the balloon to clear oesophageal secretions |
| Minnesota | As above plus an oesophageal aspiration port | Clears saliva and blood above the balloon |
| Linton–Nachlas | Single large gastric balloon with aspiration ports | Mainly for gastric varices |

## Complications

- Aspiration pneumonia, the most common serious complication.
- Oesophageal ulceration, necrosis or rupture, especially with high or prolonged oesophageal balloon pressure.
- Airway obstruction if the gastric balloon deflates or migrates up into the pharynx.
- Rebleeding when the balloons are deflated, in a large share of patients.
- Chest pain, arrhythmias and discomfort; tube displacement.

## Next step

- Arrange definitive treatment (band ligation or TIPS) while the tube controls bleeding: involve gastroenterology and interventional radiology early.
- Deflate the oesophageal balloon first, then the gastric balloon, and watch for rebleeding before removal.
- Watch for sudden respiratory distress: cut and remove the tube if the balloon has migrated.
- Continue vasoactive drugs and antibiotic prophylaxis, and correct coagulopathy as the unit decides.
- After recovery, plan secondary prophylaxis (repeat banding and a non-selective beta-blocker) and treat the liver disease.

## Test yourself

Think of the answer, then tap the question to see it.

## What must be done before inserting a Sengstaken–Blakemore tube?

Secure the airway with intubation, check both balloons for leaks, and start vasoactive drugs, antibiotics and transfusion alongside.

## Why is an X-ray taken before full inflation of the gastric balloon?

To confirm the balloon lies in the stomach below the diaphragm; inflating it in the oesophagus can rupture the oesophagus.

## Why are scissors kept at the bedside of a patient with a tamponade tube?

If the gastric balloon deflates or migrates into the pharynx and blocks the airway, the tube is cut to deflate all balloons at once.

## Why is balloon tamponade only a temporary measure?

Bleeding returns in many patients after deflation and prolonged pressure causes necrosis, so it bridges to band ligation or TIPS within about a day.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-skills/balloon-tamponade-for-bleeding-varices/)

## Elsewhere in DurgiPedia

- [Upper and lower gastrointestinal bleeding](https://durgical.com/en/clinical-exam/upper-and-lower-gastrointestinal-bleeding/)
- [Blood transfusion: bedside checks, monitoring and reactions](https://durgical.com/en/nursing/blood-transfusion-bedside-checks-monitoring-and-reactions/)

## Connections

## Related 4

- [Upper GI endoscopy](https://durgical.com/en/clinical-skills/upper-gi-endoscopy/)
- [Central venous catheter: sites, Seldinger technique and checks](https://durgical.com/en/clinical-skills/central-venous-catheter-sites-seldinger-technique-and-checks/)
- [The emergency (ABCDE) station](https://durgical.com/en/clinical-skills/the-emergency-station/)
- [Coagulation tests: PT/INR, aPTT, fibrinogen and D-dimer](https://durgical.com/en/clinical-skills/coagulation-tests-pt-inr-aptt-fibrinogen-and-d-dimer/)

## Related conditions 5

- [Upper gastrointestinal bleeding](https://durgical.com/en/conditions/upper-gastrointestinal-bleeding/)
- [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/)
- [Portal hypertension](https://durgical.com/en/conditions/portal-hypertension/)
- [Hepatic encephalopathy](https://durgical.com/en/conditions/hepatic-encephalopathy/)
- [Hypovolaemic shock](https://durgical.com/en/conditions/hypovolaemic-shock/)

## In Pharmacology 4

- [Terlipressin](https://durgical.com/en/pharmacology/terlipressin/)
- [Octreotide](https://durgical.com/en/pharmacology/octreotide/)
- [Ceftriaxone](https://durgical.com/en/pharmacology/ceftriaxone/)
- [Propranolol](https://durgical.com/en/pharmacology/propranolol/)

[← All clinical skills](https://durgical.com/en/clinical-skills/)

Educational content; it does not replace supervised hands-on training, your institution's protocols or a prescriber's order. A procedure is learnt with a teacher and done only once you are trained to do it.

Sources: [Sengstaken-Blakemore Tube](https://www.ncbi.nlm.nih.gov/books/NBK558924/) (StatPearls (NCBI Bookshelf), 2025); [Esophageal Varices](https://www.ncbi.nlm.nih.gov/books/NBK448078/) (StatPearls (NCBI Bookshelf), 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-skills/balloon-tamponade-for-bleeding-varices/