Clinical Practice and Cases in Emergency Medicine

Introduction: Variceal hemorrhage is a life-threatening complication of portal hypertension that requires rapid hemorrhage control. Gastroesophageal balloon tamponade devices are effective temporizing measures when endoscopic or definitive therapies are delayed or unsuccessful, but placement can be technically challenging during active bleeding. A bougie-assisted technique has been proposed to improve ease and success of placement.

Case Series: We describe three patients with cirrhosis and varices who presented with massive upper gastrointestinal bleeding and hemorrhagic shock. All received standard medical therapy and required escalation due to ongoing bleeding. In each case, a Sengstaken-Blakemore tube was placed using a bougie tracheal tube introducer as a semirigid stylet. The device was advanced under laryngoscopy through the esophagus and into the stomach without procedural complications. Hemostasis was achieved in all cases following balloon inflation, allowing hemodynamic stabilization and transition to definitive therapies. Two patients ultimately died due to complications of hypoxic-ischemic injury, while one survived to discharge. Use of the proximal gastric aspiration port appeared to reduce the risk of tip displacement compared to distal port insertion.

Conclusion: Bougie-assisted gastroesophageal balloon tamponade device placement is a practical and effective modification for managing catastrophic upper gastrointestinal hemorrhage, and this approach may improve placement success and speed when standard technique has been unsuccessful. Wider adoption of this readily available adjunct could enhance procedural reliability, although further study is needed to better define outcomes and optimal technique.