A prospective, randomized trial of endoscopic band ligation vs. epinephrine injection for actively bleeding Mallory-Weiss syndrome.
BACKGROUND
Effective hemostatic treatment is mandatory for patients with actively bleeding Mallory-Weiss syndrome. This study evaluated the respective efficacy and the safety of endoscopic band ligation and endoscopic epinephrine injection in Mallory-Weiss syndrome.


METHODS
Thirty-four consecutive patients with actively bleeding Mallory-Weiss syndrome were prospectively enrolled and were randomly assigned to undergo endoscopic band ligation or endoscopic injections of a 1:10,000 solution of epinephrine. Demographic characteristics, endoscopic variables, and outcome parameters, including rates of hemostasis and recurrent bleeding, were analyzed.


RESULTS
The number of elastic bands applied was one or two; the mean volume of epinephrine injected was 18.0 mL: 95% CI[16.8, 19.2]. There was no significant difference between the groups with respect to age, gender, alcohol ingestion, presenting symptoms, Hb level, shock, comorbid diseases, coagulopathy, tear location, blood transfusion, or duration of hospitalization. Primary hemostasis was achieved in all 17 patients in the band ligation group and in 16 of 17 patients (94.1%) in the epinephrine injection group. There was no recurrence of bleeding or major complication in either group.


CONCLUSIONS
In this small study, no difference was detected in the efficacy or the safety of band ligation vs. epinephrine injection for the treatment of actively bleeding Mallory-Weiss syndrome.
Park
Chang-Hwan
CH
Department of Internal Medicine, Division of Gastroenterology, Chonnam National University Medical School, Gwangju, Korea.
Min
Sang-Woon
SW
Sohn
Young-Hae
YH
Lee
Wan-Sik
WS
Joo
Young-Eun
YE
Kim
Hyun-Soo
HS
Choi
Sung-Kyu
SK
Rew
Jong-Sun
JS
Kim
Sei-Jong
SJ
D016099:Endoscopy, Gastrointestinal; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008026:Ligation; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D004837:Epinephrine