Effective endoscopic treatment of Mallory-Weiss syndrome using Glasgow-Blatchford score and Forrest classification.
OBJECTIVE
There is limited data on whether scoring systems can be used to predict clinical outcomes in patients with upper gastrointestinal bleeding due to Mallory-Weiss syndrome (MWS). We aimed to evaluate whether the Glasgow-Blatchford score (GBS) could be effective in predicting clinical outcomes of bleeding MWS and to investigate the predictive ability of the Forrest classification for rebleeding and assess the effective endoscopic modalities for bleeding control in MWS.


METHODS
From January 2004 to December 2012 168 patients were diagnosed with MWS in the Asan Medical Center Emergency Department. We analyzed their clinical outcomes, including endoscopic treatment, transfusion and admission as well as the rates of rebleeding and mortality using GBS and the Forrest classification, retrospectively.


RESULTS
Endoscopic treatment was applied to patients. The GBS was significantly higher in patients treated with endoscopic therapy than in the conservative treatment group (6.8 ± 3.7 vs 5.1 ± 4.7, P = 0.011). In patients with a GBS of >6 the rates of endoscopic treatment and rebleeding and the need for transfusion and admission were significantly higher (all P < 0.05). The Forrest classification was able to predict recurrent bleeding (area under the receiver operating characteristic curve 0.723, 95% confidence interval 0.609-0.836, P = 0.025). Hemoclip-based therapy and band ligation achieved higher success rates than did injection therapy alone in preventing rebleeding (96.4%, 88.9% and 71.4%, P = 0.013).


CONCLUSIONS
In MWS, GBS might be useful for predicting clinical outcomes and the Forrest classification in predicting recurrent bleeding.
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Sunpyo
S
Lee
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Ji Yong
JY
Ahn
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Hwoon-Yong
HY
Jung
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Kee Wook
KW
Jung
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Jeong Hoon
JH
Lee
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Do Hoon
DH
Kim
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Kee Don
KD
Choi
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Ho June
HJ
Song
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Gin Hyug
GH
Lee
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Jin-Ho
JH
Kim
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Seon-Ok
SO
Kim
D000328:Adult; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
Forrest classification; Glasgow-Blatchford score; Mallory-Weiss syndrome; endoscopy; hemorrhage