The cardias is found ulcerated due to the Sengstaken-Blakemore tube, patient had two more ulcers one in the middle third and upper third. Balloon tamponade is used if sclerotherapy and vasoconstrictor therapy fail to control variceal bleeding or are contra-indicated. The usual tube is a Sengstaken- Blakemore which is passed into the stomach. The gastric balloon is inflated; the esophageal balloon is inflated only if bleeding is not controlled by the gastric balloon. The technique is successful in 90% of cases. Serious complications, with a 5% mortality, include aspiration pneumonia, esophageal rupture and mucosal ulceration. It is very unpleasant for the patient. Note that balloon tamponade is a temporary measure and it may cause pressure necrosis after 48-72 hours. Thus sclerotherapy or some other means of control should be used after 12-24 hours.
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