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Clinical Presentation and Endoscopic Management of Mallory-Weiss Tear

5 Year Experience in an Inner-City Hospital

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Banerjee, Subhra MD*; Gumaste, Vivek MD; Angelova, Maria MD

American Journal of Gastroenterology: September 2008 - Volume 103 - Issue - p S13
Supplement Abstracts Submitted for the 73rd Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Gastroenterology, Mount Sinai Services at Elmhurst Hospital Center, Elmhurst, NY, Pediatrics, Winthrop University Hospital, Mineola, NY.

Purpose: To identify incidence, location, clinical presentation, need for endoscopic intervention and outcome of Mallory-Weiss tear in an inner-city community hospital setting.

Methods: Endoscopic data from Esophagogastroduodenoscopies (EGDs), done at Mount Sinai Services at Elmhurst Hospital Center, Elmhurst, NY between 2002 and 2007 were reviewed to identify patients with Mallory-Weiss tear. Demographic data, medical history, examination findings, laboratory data, endoscopic finding and details of therapy for patients treated for Mallory-Weiss tear were reviewed retrospectively.

Results: A total of 5604 EGDs were done over a 5 year period. Out of those 5604 EGDs acute gastro-intestinal bleeding was the indication in 1040 cases (main indication was hematemesis in 368, malena in 569 and hematochezia in 103 patients). Mallory-Weiss tear was documented to be the cause of bleeding in 35 (3.4%) out of those 1040 patients presenting with acute GI bleeding. Most common location was distal esophagus (86%), followed by cardia (14%). Out of total 35 patients diagnosed with Mallory-Weiss tear, 30 (86%) were male and 5 (14%) were female. Mean age at presentation was 50.7 years (Range 22–89 years). 24 patients (69%) did not show any active bleeding at endoscopy and no endoscopic therapy was done in those patients; whereas 11 patients (31%) were found to have active bleeding from Mallory-Weiss tear at endoscopies. Out of those 11 patients (31%) actively bleeding from Mallory-Weiss tear, bleeding was successfully controlled with endoscopic therapy in all of them and there was no recurrent bleeding; 3 patients were treated with epinephrine injection alone, 5 with epinephrine plus heater probe, 2 with epinephrine plus endoclips, and 1 with banding. None of the patients needed surgical intervention. Average length of hospital stay was 4.4 days (Range 1–42 days). 3 patients died during the same hospital stay; however cause of death was not directly related to GI bleeding.

Conclusion: Although some studies indicate that up to 30% of patients with Mallory-Weiss tear may require surgical intervention, our study indicates otherwise. All actively bleeding patients in our study (11 out of 35) were effectively controlled with endoscopic intervention. Hence, we conclude that active bleeding from Mallory-Weiss tear can be effectively controlled with endoscopic intervention and recourse to surgical intervention is not warranted.

© The American College of Gastroenterology 2008. All Rights Reserved.