title: Endoscopic band ligation could decrease recurrent bleeding in Mallory-Weiss syndrome as compared to haemostasis by hemoclips plus epinephrine.
abstract: BACKGROUND
  Mallory-Weiss syndrome (MWS) with active bleeding at endoscopy may require endoscopic haemostasis the modalities of which are not well-defined.
  
  
  OBJECTIVE
  To compare the efficacy of endoscopic band ligation vs. hemoclip plus epinephrine (adrenaline) in bleeding MWS.
  
  
  METHODS
  From 2001 to 2008, 218 consecutive patients with a MWS at endoscopy were hospitalized in our Gastrointestinal Bleeding Unit. In 56 patients (26%), an endoscopic haemostasis was required because of active bleeding. Band ligation was performed in 29 patients (Banding group), while hemoclip application plus epinephrine injection was performed in 27 patients (H&E group). Treatment efficacy and early recurrent bleeding were retrospectively compared between the two groups.
  
  
  RESULTS
  Primary endoscopic haemostasis was achieved in all patients. Recurrent bleeding occurred in 0% in Banding group vs. 18% in H&E group (P = 0.02). The use of hemoclips plus epinephrine (OR = 3; 95% CI = 1.15-15.8) and active bleeding at endoscopy (OR = 1.9; 95% CI = 1.04-5.2) were independent predictive factors of early recurrent bleeding.
  
  
  CONCLUSIONS
  Haemostasis by hemoclips plus epinephrine was an independent predictive factor of rebleeding. This result suggests that band ligation could be the first choice endoscopic treatment for bleeding MWS, but requires further prospective assessment.
authors.affiliation: Gastroenterology Department, Digestive Endoscopy Unit, Rouen University Hospital, Rouen Cedex, France. stephane.lecleire@churouen.fr
authors.forename: S
authors.initials: S
authors.lastname: Lecleire
authors.forename: M
authors.initials: M
authors.lastname: Antonietti
authors.forename: I
authors.initials: I
authors.lastname: Iwanicki-Caron
authors.forename: A
authors.initials: A
authors.lastname: Duclos
authors.forename: S
authors.initials: S
authors.lastname: Ramirez
authors.forename: E
authors.initials: E
authors.lastname: Ben-Soussan
authors.forename: S
authors.initials: S
authors.lastname: Hervé
authors.forename: P
authors.initials: P
authors.lastname: Ducrotté
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods* / Q000592:standards; D006801:Humans; D008026:Ligation; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D013525:Surgical Instruments; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine