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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(05): E653-E658
DOI: 10.1055/a-1784-0655
Original article

International multicenter study comparing demographics, therapy and outcomes in bleeding from Mallory Weiss tears and peptic ulcers

Jennifer E. Tham
1   Glasgow Royal Infirmary, Glasgow, UK
,
Lucy Lynch
1   Glasgow Royal Infirmary, Glasgow, UK
,
Stig B. Laursen
2   Odense University Hospital, Odense, Denmark
,
Loren Laine
3   Yale School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Connecticut, United States
,
Harry R. Dalton
4   Royal Cornwall Hospital, Cornwall, UK
,
Jeffrey Ngu
5   Singapore General Hospital, Singapore
,
Eduardo Redondo-Cerezo
6   Hospital Universitario Virgen de las Nieves, Granada, Spain
,
Michael Schultz
7   University of Otago, Dunedin, New Zealand
,
Iain Murray
4   Royal Cornwall Hospital, Cornwall, UK
,
Nick Michell
4   Royal Cornwall Hospital, Cornwall, UK
,
Alan J. Morris
1   Glasgow Royal Infirmary, Glasgow, UK
,
Michael M. Nielsen
2   Odense University Hospital, Odense, Denmark
,
Adrian J. Stanley
1   Glasgow Royal Infirmary, Glasgow, UK
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Abstract

Background and study aims Mallory Weiss tears (MWTs) are relatively uncommon causes of upper gastrointestinal bleeding (UGIB), and patients are generally considered at low risk of poor outcome, although data are limited. There is uncertainty about use of endoscopic therapy. We aimed to describe and compare an international cohort of patients presenting with UGIB secondary to MWT and peptic ulcer bleeding (PUB).

Patients and methods From an international dataset of patients undergoing endoscopy for acute UGIB at seven hospitals, we assessed patients with MWT bleeding, including the endoscopic stigmata and endoscopic therapy applied. We compared baseline parameters, rebleeding rate, and 30-day mortality between patients with MWT and PUB.

Results A total of 3648 patients presented with UGIB, 125 of whom (3.4 %) had bleeding from a MWT. Those patients were younger (61 vs 69 years, P < 0.0001) and more likely to be men (66 % vs 53 %, P = 0.006) compared to the patients PUB. The most common endoscopic stigmata seen in MWTs were oozing blood (26 %) or clean base (26 %). Of the patients with MWT, 53 (42 %) received endoscopic therapy. Forty-eight of them (90 %) had epinephrine injections and 25 (48 %) had through-the-scope clips. The rebleeding rate was lower in MWT patients compared with PUB patients (4.9 % vs 12 %, P = 0.016), but mortality was similar (5.7 vs 7.0 %, P = 0.71).

Conclusions Although patients presenting with MWT were younger, with a lower rebleeding rate, their mortality was similar to that of patients with PUB. Endoscopic therapy was applied to 42 % MWT patients, with epinephrine injection as the most common modality.

Supplementary material



Publication History

Received: 23 September 2021

Accepted after revision: 31 December 2021

Article published online:
13 May 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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