ZSFG AM Report Pearls 7/14/17: Minnesota Tube for Hemostasis in Variceal Upper GI Bleed

 

Thank you to Claire Debolt for presenting an interesting and unfortunate case of massive upper GI bleed in a patient with cirrhosis that ultimately went to IR and the OR.

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Top Pearls:

  • A Minnesota tube is a flexible tube with a gastric and esophageal balloon (and aspiration ports) that can be used to tamponade esophageal varices
  • Minnesota tubes are a temporary solution to achieve hemostasis
  • A Minnesota tube’s esophageal balloon cannot remain inflated indefinitely as this could cause esophageal necrosis.

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Acute Variceal Hemorrhage:

Triage:

  • Vitals (including orthostatics, if appear normal upfront)
  • Access (16G x2 at least)
  • Level of care (think about risk of decompensation)

 

Management Principles:

  • Hemodynamic Resucitation:
    • Volume resuscitation
    • Blood transfusion
  • Prevention and Treatment of Complications:
    • Consider airway protection if active hematemesis or altered mental status (or need urgent endoscopy)
    • IV Antibx w/ 3rd generation Cephalosporin (i.e. Ceftriaxone)
  • Treatment of Bleeding:
    • Address coagulopathies
    • PPI
    • Octreotide (or other somatostatin analogue)

Variceal Bleeding

Use of Minnesota Tube for Upper GI Bleed:

  • Consider as a temporary short-term way to achieve hemostasis in patients with bleeding varices
  • Success rates have been between 30-90% (variability is multifactorial)
  • Should be working on getting definitive therapy (endoscopy therapy, TIPS, or surgery)

The Minnesota Tube

  • Flexible plastic tube with 4 important components
  • Gastric Aspiration Port
  • Gastric Balloon (400cc)
  • Esophageal Balloon (inflated typically to 40mmHg)
  • Esophageal Aspiration Port

Minnesota Tube

  • Used to stop bleeding in Upper GI bleed due to esophageal varices
  • Traction applied so that the gastric balloon compresses the GE junction to reduce blood flow to the esophageal varices.
  • Esophageal balloon inflated if the gastric balloon + traction does not stop bleeding (note esophageal balloon should only be inflated for 6 hours at a time as this could lead to necrosis).

UCSF-Fresno Video Of Inserting Minnesota Tube (Viewer Discretion advised):  https://youtu.be/SVbn6Ozpvms

Sources:

 

Evernote:

 

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