Endoscopic injection therapy in bleeding Mallory-Weiss syndrome: a randomized controlled trial.
BACKGROUND
Endoscopic injection is widely used in the therapy of bleeding gastroduodenal ulcers, but its role in the management of bleeding Mallory-Weiss tears has not been properly assessed.


METHODS
Sixty-three patients undergoing emergency endoscopy in whom there was a high index of suspicion that a Mallory-Weiss tear was the source of bleeding were randomly assigned to undergo endoscopic injection therapy (epinephrine and polidocanol) or no endoscopic therapy in 2 university-affiliated hospitals. Rates of recurrent bleeding, transfusion requirements, complications, mortality, and length of hospital stay were determined for both groups of patients.


RESULTS
Bleeding recurred in 8 patients in the control group versus only 2 in the endoscopic treatment group (25.8% vs. 6.2%, p < 0.05). Hospital stay was longer for the control group (5.5 +/- 0.2, median 6.0, range 2.0-8.0 days vs. 3.4 +/- 0.2, median 3.0, range 2.0-6.0 days; p < 0.001). There was a trend toward a higher transfusion requirement after endoscopy in the control group versus the patients treated by injection (0.9 +/- 0.2, median 0.0, range 0.0-4.0 units vs. 0.2 +/- 0.1, median 0.0, range 0.0-2.0 units; p = 0.09). No complications or adverse events caused by endoscopic injection were noted. Two patients in the control group died of causes unrelated to bleeding.


CONCLUSIONS
Endoscopic injection therapy is a useful option in the management of patients with Mallory-Weiss syndrome at high risk for recurrent bleeding.
Llach
J
J
Endoscopy Unit, Gastroenterology Department, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, and Hospital Insular de Gran Canaria, Barcelona, Catalonia, Spain.
Elizalde
J I
JI
Guevara
M C
MC
Pellisé
M
M
Castellot
A
A
Ginès
A
A
Soria
M T
MT
Bordas
J M
JM
Piqué
J M
JM
D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005773:Gastroscopy; D006489:Hemostatic Techniques; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011336:Probability; D012016:Reference Values; D016896:Treatment Outcome
D000077423:Polidocanol; D011092:Polyethylene Glycols; D004837:Epinephrine