Diagnosis, Clinical Course, and Endoscopic Therapy in Mallory-Weiss Syndrome

Year 2018, Volume: 26 Issue: 2, 41 - 45, 25.09.2018

Muhammet Yener Akpınar , Zeki Mesut Yalın Kılıç Erkin Öztaş , Volkan Gökbulut , İsmail Hakkı Kalkan , Meral Akdoğan Kayhan Sabite Kaçar , Hale Gökcan Yasemin Özderin Özin Ertuğrul Kayaçetin

https://doi.org/10.17940/endoskopi.460082

Abstract

Background and Aims: Mallory-Weiss syndrome is responsible for upper gastrointestinal bleeding with a 1%-4% frequency. Most patients with Mallory-Weiss syndrome have a clinically mild course and do not require specific endoscopic treatment. However, some patients with Mallory-Weiss syndrome have severe bleeding. Endoscopic treatment of Mallory-Weiss syndrome is not standardized when compared with that of bleeding ulcers. Here we aim to share our patients’ demographic properties, applied endoscopic treatments, and clinical courses of patients. Materials and Methods: We researched our patients with Mallory-Weiss syndrome in Türkiye Yüksek İhtisas Training and Research Hospital Endoscopic Unit between 2010 and 2017. Results: Overall, 37 patients (males/females: 29/8, mean age: 63.4±19.4 years) were included in the study. Mallory-Weiss syndrome occurred in 15 patients in whom routine endoscopic procedures were performed. Stigmata of active bleeding were observed in 27 patients. Primary hemostasis was achieved in 25 patients with 92.5% frequency. Endoscopic procedures including placement of hemoclips, injection of epinephrine, and thermocoagulation with a heater probe were performed in patients with stigmata of active bleeding. Patients were divided into two groups depending on whether the origin of Mallory-Weiss syndrome was iatrogenic. Hospital stays, erythrocyte transfusion rates, primary hemostasis, stigmata of active bleeding, and frequencies of hiatal hernia were compared between the two groups. There were no differences between the two groups. Placement of hemoclips was performed in 27 patients; 19 patients received hemoclips alone whereas 8 patients received hemoclips with epinephrine injections. Mortality was not observed in any of our patients. Conclusion: Although most patients with Mallory-Weiss syndrome have benign clinical courses, it is important to keep in mind that Mallory-Weiss syndrome can be associated with severe bleeding. Hemoclip placement is an effective endoscopic treatment method in Mallory-Weiss syndrome.

Keywords

Endoscopy, gastrointestinal system bleeding, Mallory-Weiss syndrome

Mallory-Weiss Sendromunda Tanı, Klinik Seyir ve Endoskopik Tedavi

Abstract

Giriş ve Amaç: Mallory-Weiss sendromu üst gastrointestinal sistem kanamalarının %1-4 kadarından sorumludur. Çoğu Mallory-Weiss sendromu spesifik endoskopik tedavi gerektirmeyen bir şekilde hafif kanama ile seyreder; bununla beraber bazı olgularda kanama abondan olabilir. Ülser kanamalarından farklı olarak Mallory-Weiss sendromunda endoskopik tedavi çok iyi standartize edilmemiştir. Biz bu çalışmamızda kendi olgularımızın demografik özelliklerini, uygulanılan endoskopik tedavileri ve hastaların klinik seyirlerini karşılaştırmayı hedefledik. Gereç ve Yöntem: Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Endoskopi ünitesinde 2010-2017 tarihleri arasında Mallory-Weiss sendromu tanısı almış hastalar retrospektif olarak incelendi. Bulgular: Çalışmaya toplam 37 hasta (erkek/kadın: 29/8, yaş ortalaması: 63,4±19,4) dahil edildi. Bu hastaların Mallory-Weiss laserasyonu endoskopi esnasında oluşan hasta sayısı 15 olup hastaların 27 tanesinde aktif kanama belirtisi vardı. Primer hemostaz 25 hastada %92,5 sıklıkta izlendi. Aktif kanama belirtisi olan hastalara uygulanılan endoskopik tedaviler adrenalin enjeksiyonu, klips uygulaması, heater prob idi. Mallory-Weiss sendromu oluşumuna göre hastalar iatrojenik Mallory-Weiss sendromu olan ve olmayan hastalar olarak iki gruba ayrıldı. Hastanede yatış varlığı, eritrosit süspansiyonu verilme ihtiyacı, aktif kanama belirtisi varlığı, hiatal herni varlığı ve uygulanılan endoskopik tedaviler karşılaştırıldığında bu parametreler açısından gruplar arasında fark yoktu. Toplam 27 hastaya klips uygulaması yapılmıştı; bu hastaların 19 tanesine sadece klips uygulanırken 8 tanesine ise klips ile beraber adrenalin uygulaması yapıldı. Hastalarımızda mortalite izlenmedi. Sonuç: Mallory-Weiss sendromlu çoğu hasta klinik olarak benign seyir gösterse de bu hastaların şiddetli kanama ile beraber olacakları akılda tutulmalıdır. Hemoklipsler tedavide etkin ve güvenli bir endoskopik tedavi yöntemidir.

Keywords

Endoskopi, gastrointestinal sistem kanaması, Mallory-Weis sendromu

References

• 1- Gibson JA, Odze RD. Pathology of diseases that cause upper gastrointestinal tract bleeding. Gastrointest Endosc Clin N Am 2011;21:583-96.
• 2- Yin A, Li Y, Jiang Y, et al. Mallory-Weiss Syndrome: clinical and endoscopic characteristics: Eur J Intern Med 2012;23:e92-6.
• 3- Bektas M, Korkut E, İdilman R, et al. Treatment of Mallory-Weiss Syndrome using argon plasma coagulation. Endoskopi 2011;19:68-70.
• 4- Cho YS, Chae HS, Kim HK, et al. Endoscopic band ligation and endoscopic hemoclip placement for patients with Mallory-Weiss syndrome and active bleeding. World J Gastroenterol 2008;14:2080-4.
• 5- Park CH, Min SW, Sohn YH, et al. A prospective, randomized trial of endoscopic band ligation vs epinephrine injection for actively bleeding Mallory-Weiss syndrome. Gastrointest Endosc 2004;60:22-7.
• 6- Ljubičić N, Budimir I, Pavić Tet, al. Mortality in high-risk patients with bleeding Mallory-Weiss syndrome is similar to that of peptic ulcer bleeding. Results of a prospective database study. Scand J Gastroenterol 2014;49:458-64.
• 7- Lee S, Ahn JY, Jung HY et al. Effective endoscopic treatment of Mallory-Weiss syndrome using Glasgow-Blatchford score and Forrest classification. J Dig Dis 2016;17:676-84.
• 8- Chung IK, Kim EJ, Hwang KY, et al. Evaluation of endoscopic hemostasis in upper gastrointestinal bleeding related to Mallory-Weiss syndrome. Endoscopy 2002;34:474-9.
• 9- Peng YC, Tung CF, Chow WK, et al. Effi- cacy of endoscopic isotonic saline-epinephrine injection for the management of active Mallory-Weiss tears. J Clin Gastroenterol 2001;32:119-22.
• 10- Huang SP, Wang HP, Lee YC, et al. Endoscopic hemoclip placement and epinephribe injection for Mallory-Weis syndrome with active bleeding. Gastrointest Endosc 2002;55:842-6.
• 11- Higuchi N, Akahoshi K, Sumida Y et al. Endoscopic band ligation therapy for upper gastrointestinal bleeding related to Mallory-Weiss syndrome. Surg Endosc 2006;20:1431-4.
• 12- Cho YS, Chae HS, Kim HK, et al. Endoscopic band ligation and endoscopic hemoclip placement for patients with Mallory-Weiss syndrome and active bleeding. World J Gastroenterol 2008;14:2080-4.
• 13- Lecleire S, Antonietti M, Iwanicki-Caron I, et al. Endoscopic band ligation could decrease recurrent bleeding in Mallory-Weiss syndrome as compared to haemostasis by hemoclips plus epinephrine. Aliment Pharmacol Ther 2009;30:399-405.
• 14- Shimoda R, Iwakiri R, Sakata H, et al. Endoscopic hemostasis with metallic hemoclips for iatrogenic Mallory-Weiss tear caused by endoscopic examination. Dig Endosc 2009;21:20-3.
• 15- Corral JE, Keihanian T, Kröner PT, et al. Mallory Weiss syndrome is not associated with hiatal hernia: a matched case-control study. Scand J Gastroenterol 2017;52:462-4.