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Endoscopic hemostasis with metallic hemoclips for iatrogenic Mallory-Weiss tear caused by endoscopic examination
Ryo Shimoda1, Ryuichi Iwakiri, Hiroyuki Sakata
1Department of Internal Medicine, Saga Medical School, Saga, Japan.
Aim:
Applied endoscopic techniques including mucosal resection, sclerotherapy and endoscopic retrograde cholangiopancreatography (ERCP) have been advanced and iatrogenic complications including Mallory-Weiss tear (MWT) occasionally occur in daily endoscopic procedures. The present study aimed to examine the advantages of clipping for MWT complications that occur during endoscopic examination.
Methods:
Over 10 years, we experienced 47 patients with bleeding caused by MWT. Metallic hemoclips were applied for 38 patients for hemostasis. These patients were categorized into two groups: 18 patients in group A whose bleeding tear occurred during endoscopic examination in an iatrogenic condition, and 20 patients in group B visited the emergency unit due to other etiology of MWT.
Results:
The background characteristics, including length of tears, were not different between the two groups. Initial hemostasis was 100% in groups A and B. Rebleeding was 0/18 (0%) in group A and 1/20 (5 %) in group B. Number of patients who received blood transfusion was significantly higher in group B (group A: 0/18, group B: 4/20). Hemoglobin level before hemostasis was 12.5 g/dL in group A which was not different to that in group B, 10.9 g/dL.
Conclusion:
Application of hemoclips was effective for bleeding MWT during endoscopic procedures, which warranted prophylactic application of hemoclips on MWT during endoscopic examination.
Insights
Hemostatic clipping effectively treats bleeding Mallory-Weiss tears (MWT) during endoscopic procedures. Prophylactic clipping is recommended for MWT occurring during examinations to prevent complications.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
Background:
- Endoscopic procedures can cause iatrogenic Mallory-Weiss tears (MWT).
- Bleeding MWT is a potential complication of endoscopic interventions.
Purpose of the Study:
- To evaluate the efficacy of endoscopic hemoclip application for managing bleeding MWT.
- To compare outcomes of hemoclip therapy for iatrogenically induced MWT versus other etiologies.
Main Methods:
- A retrospective analysis of 47 patients with bleeding MWT over 10 years.
- Hemoclip application for hemostasis in 38 patients.
- Comparison of outcomes between iatrogenic MWT (Group A) and non-iatrogenic MWT (Group B).
Main Results:
- Initial hemostasis was achieved in 100% of patients in both groups.
- Rebleeding occurred in 0% of Group A and 5% of Group B.
- Group B patients required significantly more blood transfusions than Group A.
Conclusions:
- Endoscopic hemoclip application is a highly effective treatment for bleeding MWT.
- Prophylactic hemoclip use during endoscopic examinations for MWT is warranted.
