To cite: Murphy EP, O’Brien SM, Regan M. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016218401 DESCRIPTION Oesophageal varices commonly develop in the setting of portal hypertension. A Sengstaken-Blakemore (SB) tube is sometimes emergently required to control oesophageal bleeding. 2 The normal portal pressure varies from 5 to 10 mm Hg. Portal hypertension occurs when the portal pressure rises above 10 mm Hg. Pressures can rise up to 30 mm Hg, so the pressure exerted and maintained on the oesophageal balloon to tamponade the varices will need to be above 30 mm Hg. The current practice is to attach a 1 L bag of saline to the tube to maintain traction. However, there are risks associated with this method of traction. These risks include pharyngeal ulcers and mouth ulcers from the local pressure effect. We describe an alternative method of maintaining traction on the SB tube. We describe the practice of securing the tube with a pair of wooden tongue depressors and padding as shown in figure 1. This has been used by the lead author for 25 years with no adverse events. The patient population includes patients with oesophageal varices. The patients ranged from 18 to 85 years of age. Over 50 patients have been treated by the lead author using this method. This is an alternative safe method of applying traction without the adverse local pressure effects. Equipment needed Equipment needed are McGill forceps, lubrication jelly, 2×60 cc syringes with a luer lock, one large bladder irrigation syringe, a sphygmomanometer or any other hand-held device for measuring pressure, and contrast with water for insertion into the gastric balloon.