Fatal complications occur frequently during use of the Sengstaken-Blakemore tube for treatment of bleeding esophageal varices. The efficacy and complications of esophageal tamponade were reviewed in 40 consecutive patients. Esophageal tamponade controlled bleeding in 22 (56%) of the patients. Major complications occurred in 14 patients (35%), and death was attributed to these complications in nine patients (22%). Regurgitation of gastric contents caused death in six patients. Two died of rupture of the esophagus and one of airway obstruction. Balloon tamponade is a difficult and dangerous technique. It should be reserved for those patients proven unequivocally to be bleeding from esophageal varices in whom massive bleeding continues despite conservative therapy and in whom surgical intervention is impossible. Prophylactic tracheostomy or endotracheal intubation prior to the use of the balloon tubes may prevent complications.