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The current role of endoscopy in Mallory-Weiss syndrome
1Department of Surgery, U.L.S.S. No. 3, Belluno, Italy.
Insights
Endoscopic hemostatic injection effectively treats Mallory-Weiss syndrome bleeding. This retrospective review of 61 patients shows endoscopy is optimal for diagnosis and treatment, with low rebleeding rates and zero mortality.
Area of Science:
- Gastroenterology
- Endoscopy
- Internal Medicine
Background:
- Mallory-Weiss syndrome is a common cause of upper gastrointestinal bleeding.
- Lesions of the gastric cardia are frequently implicated as the bleeding source.
Purpose of the Study:
- To evaluate the diagnostic and therapeutic efficacy of endoscopy in managing Mallory-Weiss syndrome.
- To assess outcomes of hemostatic injection treatment versus H2 antagonists.
Main Methods:
- Retrospective review of 61 patients diagnosed with Mallory-Weiss syndrome.
- Emergency endoscopy for diagnosis and identification of bleeding source.
- Hemostatic injection treatment for active bleeding or stigmata of recent hemorrhage.
- H2 antagonist therapy for patients without active bleeding stigmata.
Main Results:
- Endoscopy identified bleeding sources in 54% of cases, with cardia lesions being most common.
- 5% of patients had active bleeding, and 10% had stigmata of recent hemorrhage upon endoscopy.
- Hemostatic injection was administered to 9 patients; H2 antagonists were used for the remaining 52.
- The study recorded a low rebleeding rate and zero mortality.
Conclusions:
- Endoscopic diagnosis and treatment are highly effective for Mallory-Weiss syndrome.
- Hemostatic injection offers a successful therapeutic option for actively bleeding Mallory-Weiss lesions.
- Endoscopy facilitates optimal management, leading to favorable patient outcomes.
Abstract:
We have carried out a retrospective review of 61 patients with Mallory-Weiss syndrome, 9 of whom underwent hemostatic injection treatment. At emergency endoscopy, 3 patients (5%) were actively bleeding and 6 (10%) had stigmata of recent hemorrhage. Fifty-two patients had a lesion of the cardia which was the suspected source of bleeding in 33 cases (54%). In the remaining 19 cases (31%) this site was not considered responsible because other sites of bleeding were present in the upper gastrointestinal tract. The 9 patients with active bleeding or stigmata of recent hemorrhage underwent injection treatment and the other 52 patients were treated with H2 antagonists. The low rebleed rate and the zero mortality recorded in this series indicate that endoscopy is the optimum method for diagnosis and treatment of patients with Mallory-Weiss syndrome.