Endoscopic Placement of Sengstaken-Blakemore Tube Effectively Reduces Esophageal Rupture Resulting from Tube Malposition: A Propensity Score Analysis

OBJECTIVE This study aimed to evaluate the effectiveness of endoscopically assisted Sengstaken-Blakemore tube placement in reducing the tube malposition rate and resulting complications. METHODS Data was collected on 45 patients with massive esophageal variceal bleeding who underwent Sengstaken-Blakemore tube placement between January 2011 and December 2017 at our institute. This retrospective study compared the malposition rate, complication rate, and treatment outcome between the conventional blind technique (n = 28) and the endoscopically assisted technique (n = 17), using propensity score analysis to account for differences in baseline characteristics. RESULTS The rate of malpositioning of the Sengstaken-Blakemore tubes was significantly higher in the conventional blind technique group, while there were no incidents of malpositioning in the endoscopically assisted technique group (25% vs. 0%; p = 0.034). All cases of tube malpositioning in the conventional blind technique group resulted in esophageal perforation, while no perforation occurred in the endoscopically assisted group. The propensity score analysis showed that endoscopic placement was significantly better than the conventional method for esophageal rupture (adjusted RR = 0.78, 95% CI = 0.68–0.91, p = 0.002), but not significantly better for death rate (adjusted RR = 0.68, 95% CI = 0.38–1.21, p = 0.186). CONCLUSIONS Endoscopic-assisted Sengstaken-Blakemore tube placement can effectively reduce esophageal ruptures resulting from tube malpositioning. KEYWORDS endoscopic assistance, malposition rate, Sengstaken-Blakemore tube