Mallory-Weiss Research Articles

The use of argon plasma coagulation in ruptured hemorrhagic syndrome (Mallory-Weiss syndrome) complicated by ongoing bleeding

Objective: to evaluate the efficacy and safety of argon plasma coagulation for endoscopic hemostasis in Mallory-Weiss syndrome. Materials and methods: on the basis of a clinical observation of a patient admitted to the emergency department of the State Budgetary Healthcare Institution of the Moscow Region of the Children’s Central City Hospital with complaints of vomiting of scarlet blood, dark stools, weakness, dizziness. The patient underwent emergency EGDS. Results: According to the EGDS data, a linear mucosal rupture was detected in the lower third of the esophagus along the posterior wall with a transition to the stomach cardia along the lesser curvature, about 8-9 cm long (5 cm in the esophagus, 3-4 cm in the stomach), up to 2 cm deep. -3 mm, from the rupture there is a flow of scarlet blood of medium intensity, in the bottom of the defect, fibers of the submucosal and muscular layers were determined. Endoscopic hemostasis was performed: argon plasma coagulation of the rupture of the mucous membrane of the esophagus and stomach. Against the background of endoscopic treatment by argon plasma coagulation in a patient with a long rupture, hemostasis was achieved and surgical treatment was avoided, which could aggravate the condition and lengthen the treatment time. Conclusions: Argon plasma coagulation as a non-contact method of hemostasis has a limited penetration depth and is safer and more effective than other (contact) electrocoagulation methods, where, as a rule, it is difficult to control the depth of exposure. The use of this method improves the efficiency of endoscopic hemostasis, reduces economic costs, and reduces the patient’s stay in bed.

Ideal strategy for nonvariceal upper gastrointestinal bleeding.

Over 300 000 hospital admissions in the United States each year are due to patients with upper gastrointestinal (GI) bleeding (UGIB). Common etiologies of nonvariceal UGIB include peptic ulcers, mucosal erosions of the esophagus, stomach or duodenum, Mallory-Weiss tears, Dieulafoy lesions, upper GI tract malignancy, or other etiology. Peptic ulcers classified as Forrest Ia, Ib, or IIa require endoscopic hemostasis, while IIb ulcers may be considered for endoscopic clot removal with endoscopic treatment of any underlying major stigmata. Endoscopic hemostasis for ulcers classified as Forrest IIc or III is not advised due to the low risk of recurrent bleeding. Endoscopic hemostasis in ulcer bleeding can be achieved using injection, thermal, and/or mechanical modalities. This review focuses on the currently recommended endoscopic therapies of patients presenting with acute nonvariceal upper gastrointestinal hemorrhage.

Frequency of Different Causes of Upper GI Bleed Using Endoscopic Procedure

Background: Upper gastrointestinal (GI) bleeding is a significant clinical emergency that necessitates swift and precise diagnostic and therapeutic interventions. Due to its diverse etiologies, ranging from peptic ulcers to variceal bleeding, understanding these causes is crucial for effective management. Objective: To evaluate the prevalence of various causes of upper GI bleeding through endoscopic examination. Methods: This descriptive cross-sectional study was conducted at the Department of Gastroenterology, Asian Institute of Medical Sciences (AIMS), Hyderabad, involving 150 hemodynamically stable patients who had fasted for 6 to 8 hours. A comprehensive physical examination and detailed medical history preceded the endoscopic procedures. Data were captured on a structured proforma and analyzed using SPSS software, version 26.0. Results: The cohort's mean age was 50.35 years (range 18-85 years), with a male predominance of 72%. Variceal bleeding was the most common finding (64.7%), followed by peptic ulcers (24%), Mallory-Weiss tears (12.7%), vascular anomalies (13.3%), gastric ulcers (7.3%), duodenal ulcers (6%), erosive gastritis (3.3%), and esophagitis (2.7%). Conclusion: Upper GI bleeding predominantly affects older adult males, with variceal bleeding accounting for about two-thirds of cases. The diversity of underlying causes highlights the need for accurate diagnostics and tailored treatments for high-risk groups.

Perspective: Cervical laminoforaminotomy (CLF) is safer than anterior cervical diskectomy/fusion (ACDF) for lateral cervical disease.

The literature documents that laminoforaminotomy (CLF), whether performed open, minimally invasively, or microendoscopically, is safer than anterior cervical diskectomy/fusion (ACDF) for lateral cervical disease. ACDF for lateral cervical disc disease and/or spondylosis exposes patients to multiple major surgical risk factors not encountered with CLF. These include; carotid artery or jugular vein injuries, esophageal tears, dysphagia, recurrent laryngeal nerve injuries, tracheal injuries, and dysphagia. CLF also exposes patients to lower rates of vertebral artery injury, dural tears (DT)/cerebrospinal fluid fistulas, instability warranting fusion, adjacent segment disease (ASD), plus cord and/or nerve root injuries. Further, CLF vs. ACDF for lateral cervical pathology offer reduced tissue damage, operative time, estimated blood loss (EBL), length of stay (LOS), and cost. CLFs', whether performed open, minimally invasively, or microendoscopically, offer greater safety, major pros with few cons, and decreased costs vs. ACDF for lateral cervical disease.

Clinicoetiological profile of patients with gastrointestinal bleed presenting to a tertiary care hospital in Kumaon Region of Uttarakhand

Background: Gastrointestinal (GI) bleed is a common cause of medical emergency resulting in significant morbidity and mortality. GI bleeding can be classified as upper (bleeding source proximal to the ligament of Treitz) and lower (bleeding source distal to the ligament of Treitz). Aims and Objectives: The present study was aimed to determine the current clinicoetiological profile of GI bleeding in Kumaon Region of Uttarakhand. Materials and Methods: All patients presented with GI bleed (GIB) to outpatient department and Emergency department or developed the GIB during hospitalization are managed in intensive care unit (preferably) and high-dependency unit. Results: Both upper and lower GI endoscopy were twice normal in 2.7% of patients (obscure bleeding). On upper GI endoscopy findings showing esophageal varices (45.83%), gastroesophageal varices (8.33%), isolated gastric varices (8.33%), gastric ulcer (8.33%), duodenal ulcer (6.25%), Mallory-Weiss tear (6.25%), erosive gastritis (6.25%), gastric antral vascular ectasia (4.16%), gastric carcinoma (4.16%), and Dieulafoy’s lesion (2.08%). Upper GIB (UGIB) had more mortality than lower GIB, among UGIB variceal bleed having higher mortality than non-variceal bleeding. Conclusion: Unlike the evidence from the west that peptic ulcer is the most common cause of upper gastrointestinal bleeding, we found varices as the common cause, followed by peptic ulcer and erosive gastritis. Hence, the variable spectrum of the etiology of the GIB seen in our country could represent either a true epidemiological difference or reflect skewed access to health care.

Endoscopic treatment of an esophageal perforation in eosinophilic esophagitis by insertion of a self-expanding metal stent.

We present the case of a 29-year-old patient with multiple allergies, mild asthma and rhinoconjunctivitis who reported a history of esophageal impactions after ingestion of solid foods. These episodes resolved spontaneously at home and by self-induced vomiting and never required endoscopic removal. The patient presented to the emergency department due to a sensation of food impaction lasting more than 12 hours after eating meat the night before, which did not subside with the intake of liquids or self-induced vomiting. Endoscopic evaluation was requested for foreign body extraction. A meat bolus impacted in the distal esophagus was easily removed using a Roth basket, revealing a severe esophageal stricture that prevented passage of the endoscope into the gastric cavity. Furthermore, in the same area where the foreign body was previously located, a deep esophageal tear was seen. Given the high suspicion of perforation, the patient was examined, and thoracic and cervical crepitation was observed. It was decided to immediately insert, with only endoscopic control, a partially covered Ultraflex® esophageal stent measuring 18 mm in diameter and 15 cm in length. After insertion, clinical improvement and cessation of crepitation were observed.

Obstructive jaundice: epidemiology, diagnosis and choice of optimal method of biliary decompression

Aim. To analyze epidemiological features and morbidity structure in obstructive jaundice, to estimate the results of diagnosis and treatment of this category of patients and to evaluate factors affecting the effectiveness of the treatment and diagnostic program.Materials and methods. The study was based on four-year experience of treatment of 484 patients with mechanical jaundice. Ultrasound, CT, MRI, endoscopic ultrasound, and cholangioscopy were used to diagnose the level of the obstruction and the causes of obstructive jaundice. The main method of decompression involved transpapillary interventions in 365 patients. Two patients underwent choledochoduodenostomy under endoscopic ultrasound guidance. Percutaneous transhepatic interventions and “rendezvous” method were applied in 82 cases.Results. The efficacy of transpapillary endoscopic retrograde procedures in obstructive jaundice accounted for 93.4%. Complications developed in 33 patients (8.4%) including postmanipulation pancreatitis – in 19 patients (4.9%), pancreatonecrosis – in 2 patients (0.5%), bleeding – in 9 patients (2.3%), retroduodenal perforation – in 2 patients (0.5%), Mallory–Weiss syndrome – in 1 patient (0.3%). The efficacy of antegrade percutaneous transhepatic interventions comprised 95.1%, while liver parenchyma bleeding developed in 3.7% of patients. In-hospital mortality amounted to 0.8% (malignant tumor progression).Conclusion. The increasing share of patients with mechanical jaundice in the structure of general surgical emergencies, as well as the need to use high-tech equipment for diagnosis and treatment, necessitate creating centers for treatment of patients with mechanical jaundice. Retrograde and antegrade minimally invasive surgeries for specific indications are considered to be the main methods of biliary decompression.

Pathophysiological mechanisms of adaptation of the mucosa of the gastric cardia to portal hypertension

The model of before- and intrahepatic blockage of the portal system was proposed. Modeling of before-hepatic blockage of the portal system after development of toxic liver dystrophy lead to formation of the liver cirrhosis with stable portal hypertension. Gastritis with signs of hyperplastic and atrophy processes of the mucosa, formation of erosia, inflammatory infiltration of intermediate tissue and rebuilding of the glandulae were the basis of morphological changes of gastric mucosa in rats with experimental before- and intrahepatic portal blockage. Transformation of the cardiac mucosa with expressed polymorphism occured in the patients with the portal liver cirrhosis. Dystrophic and necrobiotic changes typical of hepatic gastropathy with signs of acute or chronic gastritis, formation of inflammatory infiltrates and rebuilding of the cardial mucosa into intestinal type were established microscopically. It is possible to believe that a widening of the veins leads to venous hyperemia and stasis in the portal hypertension. Therefore the morphology of the gastric mucosa was disturbed. It was accompanied bythe indurate changes and cellular destruction with erosia formation. These erosia may be a cause of rupture of the gastric mucosa in strong vomiting in Mallory-Weiss syndrome. This hypothesis needs clinic and experimental study in the future.

S2626 Utilization of Novel Hemostatic Gel for Hemostasis in an Esophageal Tear

S2626 Utilization of Novel Hemostatic Gel for Hemostasis in an Esophageal Tear

S2815 Mallory-Weiss Syndrome Marked by Sporadic Hematemesis and Extensive Clots

S2815 Mallory-Weiss Syndrome Marked by Sporadic Hematemesis and Extensive Clots

The Potential Impact of Herbal Galactagogue in India: A Review from Medical Perspective

Mallory-Weiss tear refers to a condition in which the lining of the esophagus tears due to excessive strain, resultingin bleeding. This condition is commonly caused by vomiting or retching and can lead to significant complicationsif not promptly treated. Early identification and management of Mallory-Weiss tear are critical for the preventionof further damage and the promotion of optimal patient outcomes. Clinicians should maintain a high index ofsuspicion for this condition in patients with a history of retching or vomiting and prioritize appropriate diagnosticand therapeutic interventions to minimize the risk of adverse outcomes

A Systematic Analysis of Incidence, Therapeutic Strategies, and In-hospital Mortality of Mallory-Weiss Syndrome in Germany.

Mallory-Weiss syndrome (MWS) is a rare cause of upper gastrointestinal bleeding from gaging or vomiting-induced mucosal lacerations at the gastroesophageal junction. Most cases do not require urgent endoscopic intervention due to the mostly self-limiting course. For more severe cases, different hemostasis techniques have been used. In small MWS cohorts, overall mortality was ~5%, but comprehensive data, as well as population-based incidence, treatment recommendations, and outcome parameters such as in-hospital mortality and adverse events, are largely lacking. We evaluated current epidemiological trends, therapeutic strategies, and in-hospital Mortality of MWS in Germany based on standardized hospital discharge data provided by the German Federal Statistical Office from 2010 to 2019. A total of 59,291 MWS cases, predominately male (62%), were included into analysis. The mean number of MWS cases in Germany was 5929/year and decreased continuously during the observation period (-4.1%/y). The overall annual incidence rate (as hospitalization cases per 100,000 persons) was 7.5 with the highest incidence rate in the New Federal States (8.7). The most common comorbidities were reflux esophagitis (23.6%), diaphragmatic hernia (19.7%), and alcohol abuse (10.9%). The most frequent complication was bleeding anemia (26%), whereas hypovolemic shock (2.9%) was rare. Endoscopic injection was the most commonly performed endoscopic therapy (13.7%), followed by endoscopic clipping (12.8%), whereas the need for surgical therapy was rare (0.1%). Endoscopic combination therapies were used predominantly as a combination of injection and clipping. The overall in-hospital mortality was 2.7% and did not differ through the observation period. The presence of hypovolemic shock, acute kidney injury, sepsis, artificial ventilation, adult respiratory distress syndrome, bleeding anemia, and female sex was associated with a significantly worse prognosis. Our study gives a detailed insight into the incidence, patient-related risk factors, endoscopic treatment, and overall in-hospital mortality as well as regional differences in a large MWS collective in Germany. Furthermore, we were able to identify mortality-associated complications and their impact.

Successful small-diameter endoscopic hemostasis using a self-assembling peptide matrix for Mallory-Weiss syndrome in a patient with a severe esophageal stricture

Successful small-diameter endoscopic hemostasis using a self-assembling peptide matrix for Mallory-Weiss syndrome in a patient with a severe esophageal stricture

Intractable hiccups after VNS implantation: a case report

BackgroundHiccups (medically termed, “singultus”), when intractable, can cause significant medical consequences such as aspiration, malnutrition, and depression, leading to poor quality of life. Several case reports have shown that vagus nerve stimulator (VNS) implantation can help treat central idiopathic intractable hiccups. However, we present a contrary case of a patient who developed intractable singultus following VNS placement for medically refractory epilepsy.Case presentationWe report a 71-year-old male patient with drug-resistant epilepsy who underwent VNS implantation and developed intractable hiccups shortly thereafter. The hiccups were severe and persistent, such that the patient developed a Mallory-Weiss tear, which required intensive care, invasive intubation and mechanical ventilation, and a prolonged rehabilitation course. Despite multiple therapies including phrenic nerve block and Nissen fundoplication, the patient’s hiccups persisted and only stopped once the VNS was permanently deactivated.ConclusionsLittle is known about the incidence of hiccups after VNS implantation. We present one case of hiccups as a direct consequence of VNS implantation. The clinical impact of this report is significant given the relative unfamiliarity of hiccups as an adverse effect of VNS implantation. Neurologists and epileptologists, who present VNS implantation as a surgical option for seizure control to their patients, should be aware of the possibility of singultus development and its significant physical and emotional ramifications.

AIMS65, Glasgow-Blatchford bleeding score and modified Glasgow-Blatchford bleeding score in predicting outcomes of upper gastrointestinal bleeding: An accuracy and calibration study.

Albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 years (AIMS65), Glasgow-Blatchford bleeding score (GBS) and modified GBS (mGBS) are three pre-endoscopy scoring systems used in the risk stratification of upper gastrointestinal bleeding (UGIB). The utility of such scoring systems in a population is estimated by their accuracy and calibration in the population. We aimed at validating and comparing the accuracy of the three scoring systems in predicting clinical outcomes including in-hospital mortality, need for blood transfusion, endoscopic treatment and rebleeding risk. We conducted a single-center, retrospective cohort study on patients with UGIB at a tertiary care center in India over 12 months. Clinical and laboratory data was collected from all patients admitted with UGIB. All patients were risk stratified using AIMS65, GBS and mGBS. The clinical outcome examined were: in-hospital mortality, requirement of blood transfusion, need for endoscopic treatment and rebleeding during hospital stay. The area under receiver-operating curve (AUROC) was calculated to assess the performance and calibration curves (Hosmer-Lemeshow goodness of fit curve) were plotted to examine how accurately the model describes the data of all three scoring systems. Total 260 patients were included in the study, of which 236 (90.8%) were males. As many as 144(55.4%) patients required blood transfusion and 64 (30.8%) required endoscopic treatment. While the incidence of rebleeding was 7.7%, in hospital mortality was 15.4%. Of 208 who underwent endoscopy, the most common causes identified were varices (49%) and gastritis (18.2%), followed by ulcer (11%), Mallory-Weiss tear (8.1%), portal hypertensive gastropathy (6.7%), malignancy (4.8%) and esophageal candidiasis (1.9%). The median AIMS65 score was 1, GBS 7 and mGBS 6. The area under curve (AUROC) for AIMS65, GBS and mGBS was (0.77, 0.73,0.70), (0.75, 0.82,0.83), (0.56, 0.58,0.83), (0.81, 0.94,0.53) for in-hospital mortality, blood transfusion requirement, endoscopic treatmentand rebleeding prediction, respectively. GBS and mGBS are superior to AIMS65 in predicting the requirement of blood transfusion and rebleeding risk, whereas in-hospital mortality was better predicted by AIMS 65. Both scores performed poorly in predicting the need of endoscopic treatment. An AIMS65 of 0,1 and a GBS of ≤ 1 are not associated with significant adverse events. A poor calibration of the scores in our population points to the lack of generalizability of these scoring systems.

Mallory-Weiss Syndrome with Oesophageal Tear: A Case Report

A 67-year-old male patient presented to the hospital with complaints of mild-grade fever, gradually progressive cough, and frequent episodes of vomiting. The initial diagnosis was acute gastritis with severe dehydration. The patient had a medical history of Type 2 Diabetes Mellitus (T2DM) for 2 years and Hypertension (HTN) for 20 years, for which he was already receiving treatment. Due to continuous bleeding, an urgent endoscopy was performed, revealing a linear tear in the mucous membrane of the oesophageal region, leading to a diagnosis of Mallory-Weiss Syndrome (MWS). The patient was treated with antibiotics, antipyretics, antiemetics, and antacids. Subsequently, The patient was symptomatically improved, leading to his discharge from the hospital. Keywords: Mallory Weiss Syndrome (MWS), Hypertension (HTN), Type 2 Diabetes Mellitus (T2DM)

Mallory-Weiss syndrome in four hemodialysis patients: a case study

BackgroundHemodialysis patients are prone to gastrointestinal bleeding, and Mallory-Weiss syndrome (MWS) is one of the causes. Mallory-Weiss syndrome is often induced by severe vomiting, manifests as upper gastrointestinal bleeding, and is self-limited with a good prognosis. However, mild vomiting in hemodialysis patients can lead to the occurrence of MWS, and the mild early symptoms are easy to misdiagnose, leading to the aggravation of the disease.Case presentationIn this paper, we report four hemodialysis patients with MWS. All patients displayed symptoms of upper gastrointestinal bleeding. The diagnosis of MWS was confirmed by gastroscopy. One patient had a history of severe vomiting; however, the other three reported histories of mild vomiting. Three patients received the conservative hemostasis treatment, and the gastrointestinal bleeding stopped. One patient underwent the gastroscopic and interventional hemostasis treatments. The conditions of three of the patients improved. Unfortunately, one of the patients died due to the cardia insufficiency.ConclusionsWe think that the mild symptoms of MWS are easily covered up by other symptoms. This may lead to delays in diagnosis and treatment. For patients with severe symptoms, gastroscopic hemostasis is still the first choice, and interventional hemostasis can also be considered. For patients with mild symptoms, drug hemostasis is the first consideration.

The Clinical and Endoscopic Profiles of Patients With Upper Gastrointestinal Bleeding (UGIB) and the Role of the Rockall Scoring System in Predicting Adverse Outcomes.

Upper gastrointestinal bleeding (UGIB) is one of the common emergencies seen by physicians. Upper gastrointestinal (UGI) endoscopy remains a crucial tool in the identification of UGIB. The aim of the present study was to determine the clinical and endoscopic profiles of UGIB in an adult population. This prospective, cross-sectional study was conducted in Dayanand Medical College and Hospital (DMCH), Ludhiana, where 75 patients aged 18 years and above admitted to the hospital with a history of UGIB from July 1 to December 31, 2018, were enrolled in the study. After obtaining the demographic data, all patients underwent clinical examination, laboratory investigations, and video endoscopy. The Rockall scoring system was used to assess their prognosis. The mean age of the study population was 52.19±6.65 years. Themajority (33%) were in the age group of 51-60 years. Of the study population, 82.7% were male and 17.3% were female. Chronic alcohol intake was found to be the most common risk factor, followed by drug intake. On upper gastrointestinal endoscopy, esophageal varices (65.3%) were the most common finding, followed by peptic ulcer disease (25.2%), gastric erosions (2.6%), gastroduodenitis (1.3%), Mallory-Weiss tear (1.3%), carcinoma stomach (1.3%), Camron's lesion (1.3%), andDieulafoy's lesion (1.3%). Mortality attributed to UGIB was found to be 8%. The present study reported portal hypertension as the most common cause of UGIB, while the most common endoscopic lesions reported were esophageal varices. The factors associated with poor prognosis were age >60 years, shock, respiratory failure, low hemoglobin, low platelet count, deranged international normalized ratio (INR), variceal bleed, renal failure, rebleed, Rockall score ≥ 8, and late endoscopy (>24 hours of admission). Urgent appropriate hospital management definitely helps to reduce morbidity and mortality in patients with UGIB.

Mallory-Weiss syndrome from giant gastric trichobezoar: A case report

Mallory-Weiss syndrome (MWS), representing a linear mucosal laceration at the gastroesophageal junction, is a quite frequent cause of upper gastrointestinal bleeding, usually induced by habitual vomiting. The subsequent cardiac ulceration in this condition is likely due to the concomitance of increased intragastric pressure and inappropriate closure of the gastroesophageal sphincter, collectively inducing ischemic mucosal damage. Usually, MWS is associated with all vomiting conditions, but it has also been described as a complication of prolonged endoscopic procedures or ingested foreign bodies.We described herein a case of upper gastrointestinal bleeding in a 16-year-old girl with MWS and chronic psychiatric distress, the latter of which deteriorated following her parents' divorce. The patient, who was residing on a small island during the coronavirus disease 2019 pandemic lockdown period, presented with a 2-mo history of habitual vomiting, hematemesis, and a slight depressive mood. Ultimately, a huge intragastric obstructive trichobezoar was detected and discovered to be due to a hidden habit of continuously eating her own hair; this habit had persisted for the past 5 years until a drastic reduction in food intake and corresponding weight loss occurred. The relative isolation in her living status without school attendance had worsened her compulsory habit. The hair agglomeration had reached such enormous dimensions and its firmness was so hard that its potential for endoscopic treatment was judged to be impossible. The patient underwent surgical intervention instead, which culminated in complete removal of the mass.According to our knowledge, this is the first-ever described case of MWS due to an excessively large trichobezoar.

Pneumomediastinum as a Complication of Cocaine Insufflation

A 25-year-old man presents to the ED for unresponsiveness after consuming cocaine and other unknown substances. Chest imaging from the presentation was unremarkable, but after developing fever and leukocytosis, he underwent extensive work-up in search of infectious foci. A CT scan of the chest showed a small pneumomediastinum and the possibility of an esophageal tear. After recovering consciousness and the ability to recount events, the patient admitted to the concomitant use of cocaine and opiates via insufflation.