Placement of a Sengstaken-Blakemore tube can oftentimes prove technically difficult in the emergent setting. Ascertaining correct position prior to insufflation of the gastric balloon is imperative, and oftentimes leads to significant treatment delay while awaiting xray confirmation. We present a case demonstrating a novel technique of endoscopic placement.

A fifty-five year old male with a history of decompensated alcohol cirrhosis and hepatorenal syndrome developed hematemesis and hemorrhagic shock. Emergent endoscopy was performed and due to anatomical limitations, sclerotherapy of bleeding esophageal varices was performed with moderate success. Due to continued bleeding and high risk of rebleeding, a Sengstaken-Blakemore tube was placed under direct visualization with the use of a snare and gastroscope.

The snare was used to grasp the tip of the Sengstaken-Blakemore tube and pulled tight into the scope with the tube positioned directly along side of the scope. Next, the gastroscope was then carefully advanced through the oropharynx and upper esophagus with the snare grasping the tip of the Sengstaken-Blakemore tube and pulling it through into the stomach. The scope was advanced to the antrum of the stomach and retroflexed to ensure the gastric balloon was completely located in the stomach. Next, the gastric balloon was inflated with 250 ml of air under direct visualization. After the Sengstaken-Blakemore tube was secured, the snare was then opened and removed from the endoscope. While the balloon was inflated, the endoscope was then easily withdrawn without displacing the Blakemore tube. Bleeding was successfully controlled.