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is fully inflated and withdrawn to the gastroesophageal junction, the bougie is gently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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Article info
Publication history
Published online: December 22, 2022
Accepted:
December 13,
2022
Received in revised form:
November 15,
2022
Received:
July 19,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
Published by Elsevier Inc.
