Endoscopic hemoclip placement and epinephrine injection for Mallory-Weiss syndrome with active bleeding.
BACKGROUND
Mallory-Weiss syndrome with active bleeding requires effective hemostasis. This is an investigation of the respective efficacy and safety of endoscopic hemoclip placement and endoscopic epinephrine injection in Mallory-Weiss syndrome.


METHODS
Thirty-five patients with Mallory-Weiss syndrome with spurting vessels or oozing in a university hospital were enrolled prospectively and randomly assigned to endoscopic hemoclip placement (18 patients) or endoscopic epinephrine injection (17 patients) performed by 4 endoscopists with similar clinical experiences. Demographic characteristics, endoscopic variables, and outcome parameters as well as rates of hemostasis and recurrent bleeding were analyzed.


RESULTS
The mean (SD) number of hemoclips applied was 2.5 (1.2) and the mean volume of injection was 7.9 (4.3) mL. Primary hemostasis was achieved in all 35 patients. In each group there was 1 case of recurrent bleeding. Secondary hemostasis was achieved by repeating the same procedures as at randomization in both cases. There were no significant differences in age, gender, prior ingestion of alcohol, presenting symptoms, hemoglobin level, shock, comorbid diseases, bleeding stigmata, tear location, blood transfusion, or hospitalization between the groups. There were no procedure-related complications in either group; surgery was not required in any patient. For both groups, there were no second episodes of recurrent bleeding, procedure-related complication, or need of operation.


CONCLUSIONS
Endoscopic hemoclip placement and endoscopic epinephrine injection are equally effective and safe for the management of active bleeding in Mallory-Weiss syndrome, even in patients with shock or comorbid diseases.
Huang
Shih-Pei
SP
Department of Internal Medicine, College of Medicine, National Taiwan University Taipei, Taiwan.
Wang
Hsiu-Po
HP
Lee
Yi-Chia
YC
Lin
Chun-Che
CC
Yang
Chang-Shiu
CS
Wu
Ming-Shiang
MS
Lin
Jaw-Town
JT
D000328:Adult; D000368:Aged; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D004935:Esophageal Diseases / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007267:Injections; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013525:Surgical Instruments / Q000009:adverse effects*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D004837:Epinephrine