Therapeutic alternatives for the Mallory-Weiss tear

Abstract

The Mallory-Weiss tear (MWT) is a frequent cause of upper gastrointestinal bleeding. It has been diagnosed more frequently since endoscopy was introduced. Once the diagnosis has been made, several treatment options are available. The treatment modality chosen depends on the type and location of the lesion, the patient's comorbid conditions, the availability of the different therapeutic modalities, and the experience of the endoscopist with each of these different modalities. In general, if the MWT is not actively bleeding at the time of endoscopy, no further treatment is needed owing to a low risk of rebleeding, unless a visible vessel is present. In the presence of a visible vessel or an actively bleeding vessel, then we recommend the use of any of the endoscopic treatment modalities discussed later in this article depending on the patient's condition and clinical scenario. Our review of the literature suggests that multipolar electric coagulation (MPEC) is the treatment modality with better evidence-based support for safety and bleeding control. MPEC has been associated only with very few complications. It should be avoided when esophageal varices are suspected because it may precipitate and aggravate bleeding. In such instances, either polidocanol injection or endoscopic band ligation of the tear is recommended, which is emerging as a safe and effective treatment modality even in patients without varices. In addition, epinephrine injection is an effective first-line modality. However, it should be avoided in patients with history of coronary artery disease owing to the potential for systemic absorption. Endoscopic hemoclipping (EH) is another useful treatment option and is emerging as a first-line modality. However, it is not widely available in all endoscopy emergency units. If it is available, it is a great alternative. Finally, if bleeding continues or recurs despite endoscopic therapy, the patient should be referred for surgical treatment. However, if the patient is not a surgical candidate, then radiologic hemostasis with selective vasopressin or Gelfoam embolization represents a viable treatment alternative that may be used depending on availability of a specialized interventional radiologist.

Hepatotoxic effects of polidocanol in a model of autologously perfused porcine livers

“…As polidocanol is routinely used for sclerosing varices and other vascular pathologies in the gastrointestinal tract (Morales and Baum 2003;Vlavianos and Westaby 2001) and it has recently been proposed for use in the treatment different hepatic diseases (Kaneko et al 2002;Ormeci et al 2001), the present study addressed its effects when administered to the hepatic vascular system because the liver plays an important role in the metabolism of exogenous substances due to its anatomical position between the gastrointestinal tract and the systemic circulation.…”

Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes

“…These lesions can be associated with repeated retching or vomiting and are another important cause of nonvariceal UGIB. It is estimated that 5 to 15% of all cases of acute UGIB are secondary to Mallory-Weiss tears [13,14].…”

Mallory-Weiss sendromunun argon plazma koagülasyonu ile tedavisi

“…These lacerations are oriented along the longitudinal axis of the esophagus causing repeated vomiting. Many conditions have been noted to have an association with MWS, including chronic and/or binge alcohol use (1,2). Other associations described previously include the presence of a hiatus hernia, non-steroidal anti-inflammatory agent use, portal hypertension, other mucosal pathologies, upper endoscopy, and prolonged coughing or paroxysms of coughing (3,4).…”

“…The clinical course is usually benign. For the remaining patients, in whom bleeding does not cease spontaneously, intervention is required (1). With the development of endoscopic techniques, endoscopic therapy has become the first-line treatment for actively bleeding lacerations.…”

“…With the development of endoscopic techniques, endoscopic therapy has become the first-line treatment for actively bleeding lacerations. Various endoscopic methods of hemostasis, such as injection of sclerosing agents, electrocoagulation, hemoclip placement, and endoscopic band ligation, have been used and evaluated for MWS (1,3,7).…”