ENDOSCOPIC SCLEROTHERAPY IN UPPER GASTROINTESTINAL-BLEEDING DUE TO THE MALLORY-WEISS SYNDROME

Objectives: Therapeutic endoscopic techniques have changed the need fo r emergency surgery in gastrointestinal bleeding episodes. However, th ere is only little information about endoscopic therapies in severe ga strointestinal bleeding due to the Mallory-Weiss syndrome. The aim of this clinical study was to assess the usefulness of early endoscopic e xamination and sclerotherapy for severe or recurrent bleeding due to t he Mallory-Weiss syndrome. Methods: We studied all 50 cases of gastroi ntestinal bleeding secondary to the Mallory-Weiss syndrome seen in 217 5 consecutive emergency endoscopic examinations performed in a Univers ity Hospital over a 3-year period. Endoscopic sclerotherapy (1/10000 a drenaline + 1% polidocanol) was performed in all patients with active bleeding or visible vessel at endoscopic examination. The remaining pa tients were medically treated. Results: Active bleeding or a visible v essel were found in 13 patients; definitive hemostasis was obtained in all cases with sclerotherapy. The remaining 37 patients were successf ully treated by conservative therapy. On admission, the severity of th e hemorrhagic episodes was significantly higher in patients treated wi th sclerotherapy than in those who did not require this procedure. An esophageal perforation, successfully managed by conservative means, wa s the only complication recorded in the subset of patients undergoing sclerotherapy. Conclusions: Severe bleeding due to Mallory-Weiss syndr ome can be successfully treated by sclerotherapy. Early endoscopic exa mination is an accurate procedure in identifying patients who do not r equire sclerotherapy.