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BOUGIE-FACILITATED TAMPONADE BALLOON PLACEMENT FOR MASSIVE ESOPHAGOGASTRIC VARICEAL HEMORRHAGE: A CASE SERIES AND NOVEL PROCEDURAL TECHNIQUE DESCRIPTION

  • Robert C. Whitford
    Correspondence
    Correspondence Address: Robert C. Whitford, MD, Department of Cardiothoracic Surgery, Division of Cardiovascular Critical Care, University of Louisville, 555 South 4th Street, Apt 720, Louisville, KY 40202
    Affiliations
    Department of Emergency Medicine, Division of Cardiovascular Critical Care, University of Louisville, Louisville, Kentucky

    Department of Cardiothoracic Surgery, Division of Cardiovascular Critical Care, University of Louisville, Louisville, Kentucky
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  • Jeremy Liebman
    Affiliations
    Department of Emergency Medicine, Bon Secours Mercy Health Hospital System, Cincinnati, Ohio
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  • Jessica Baez
    Affiliations
    Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
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Published:December 22, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.12.019

      Abstract

      Background

      Balloon tamponade of esophagogastric variceal hemorrhage is a lifesaving but challenging procedure. One difficulty that often arises is coiling of the tube in the oropharynx. We describe a novel use of the bougie as an external stylet to help guide placemat of the balloon to help overcome this challenge.

      Discussion

      We describe four cases in which the bougie was successfully utilized as an external stylet to place a tamponade balloon (3 Minnesota tubes, 1 Sengstaken-Blakemore tube) without any apparent complication. The straight end of the bougie is inserted approximately 0.5 cm into the most proximal of the gastric aspiration ports. The tube is then inserted into the esophagus under direct or video laryngoscopic visualization using the bougie to help “push” the tube into place as an external stylet. Once the gastric balloon is fully inflated and withdrawn to the gastroesophageal junction, the bougie is gently removed.

      Conclusion

      The bougie may be considered as an adjunct for placement of tamponade balloons for massive esophagogastric variceal hemorrhage when placement proves refractory to traditional techniques. We think this can be a valuable tool in the emergency physician's procedural repertoire.

      Keywords

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