Q: During rescuing Balloon tamponade (Sengstaken-Blakemore tube) for esophageal variceal bleeding which balloon should be inflated first? (Select one) 

A) Esophageal
B) Gastric 


Answer: B

Balloon tamponade is usually used as a last minute rescue therapy in life and death situation in massive esophageal bleeding. It requires an experienced operator as it carries a high risk of esophageal rupture. After intubation, oral route is a preferred to insert tube. The gastric tube is inflated first with about 400-500 cc of air and pulled to apply tamponade and tension via pulley usually above the head of the bed. Only if bleeding does not stop after inflation of gastric port, the esophageal port should be inflated to about 30 to 40 mmHg. Overinflation of esophageal port may rupture esophagus.