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Acute gastro-oesophageal variceal bleeding can be controlled in most patients by a correctly placed Sengstaken–Blakemore or Minnesota balloon tube if endoscopic intervention fails or the necessary expertise is not immediately available.1 The temporary control of bleeding by balloon tamponade allows time for resuscitation and correction of clotting defects which should be done promptly to limit the duration of balloon tube compression, ideally within 24 hours. As 60% of patients will re-bleed after balloon deflation without further intervention, an experienced endoscopist must be available when the tube is removed. Although newer methods including self-expanding oesophageal stents can be used for bleeding control, balloon tamponade remains the most widely available technique for immediate control, especially in smaller hospitals.2