CLINICAL AND ENDOSCOPIC RISK-FACTORS IN THE MALLORY-WEISS-SYNDROME

Objectives: Although patients with bleeding Mallory-Weiss tears are ge nerally hospitalized, we wished to develop guidelines facilitating the selection, by clinical and endoscopic criteria, of patients who do no t need hospitalization. Our specific aims were to determine whether pr esenting manifestations of bleeding different in hemodynamically unsta ble patients, whether active bleeding or stigmata of bleeding at endos copy were prognosticators for significant rebleeding, and the outcomes in endoscopically managed patients. Methods: The endoscopic and clini cal features of all patients with acute GI bleeding from a Mallory-Wei ss tear were obtained from our GI Bleeding Team database over a consec utive 4-yr period and analyzed for prognostic indicators, Results: 1) Presenting manifestations, e.g., hematochezia, were significantly diff erent in hypotensive patients, 2) Active bleeding but not stigmata was associated with higher transfusion requirements, 3) Rebleeding was un usual, occurring within 24 h, more often in patients with a bleeding/c oagulation diathesis, The median hospital stay was 4 days (range 1-24) . Fifty-seven percent of patients received transfusion (median 4 units , range 1-26 units); requirements were higher in patients with coagulo pathies. Conclusions: Patients without risk factors for rebleeding (po rtal hypertension, coagulopathy), clinical features indicating severe bleeding (hematochezia, hemodynamic instability), or active bleeding a le endoscopy can be managed with a brief period of observation, Patien ts with endoscopically active bleeding may benefit from endoscopic the rapy.