Clinical Endoscopy

Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia: Tomoaki Yamasaki, Yuhei Sakata, Takehisa Suekane, Hiroko Nebiki; Clin Endosc 2021;54(6):916-919. Published online November 12, 2020; DOI: https://doi.org/10.5946/ce.2020.220

Mallory-Weiss tears (MWT) are occasionally encountered during endoscopic procedures. Esophageal endoscopic submucosal dissection (ESD) is widely performed under general anesthesia to avoid unexpected body movements. We present the case of a 68-year-old woman with squamous cell carcinoma. Although ESD was performed under general anesthesia, a gastric perforation at the MWT caused by gastric inflation was observed after the procedure. The perforation was closed endoscopically, and she was discharged without any sequelae. Although general anesthesia is useful for esophageal ESD, it should be noted that it can cause MWT, and in rare cases, gastric perforation, due to gastric inflation during the procedure.

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Gastric Perforation Encountered during Duodenal Stent Insertion
Sung Woo Ko, Hoonsub So, Sung Jo Bang
The Korean Journal of Gastroenterology.2022; 80(5): 221. CrossRef

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Endoscopic Management of Mallory-Weiss Tearing: Hyun-Soo Kim; Clin Endosc 2015;48(2):102-105. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.102

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Mallory-Weiss tearing (MWT) is a common cause of non-variceal upper gastrointestinal bleeding. Although the majority of patients with bleeding MWT require no intervention other than hemodynamic supports, spectrum of MWT is wide, and the condition sometimes results in a fatal outcome. Endoscopic management to stop the bleeding may be required during the index endoscopy, especially in those with active bleeding or stigmata of recurrent bleeding. Most commonly used endoscopic treatment for actively bleeding MWT is injection therapy, argon plasma coagulation, hemoclip placement, and band ligation. Selection of the optimal endoscopic hemostasis depends on the physician's ability and patient's clinical status.

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Gastrointestinal Emergencies and the Role of Endoscopy
Vinod Kumar Dixit, Manoj Kumar Sahu, Vybhav Venkatesh, Varanasi Yugandhar Bhargav, Vinod Kumar, Mayank Bhushan Pateriya, Jayanthi Venkataraman
Journal of Digestive Endoscopy.2022; 13(03): 179. CrossRef
Gastric Perforation Encountered during Duodenal Stent Insertion
Sung Woo Ko, Hoonsub So, Sung Jo Bang
The Korean Journal of Gastroenterology.2022; 80(5): 221. CrossRef
Guidelines for Non-variceal Upper Gastrointestinal Bleeding
Joon Sung Kim, Byung-Wook Kim, Do Hoon Kim, Chan Hyuk Park, Hyuk Lee, Moon Kyung Joo, Da Hyun Jung, Jun-Won Chung, Hyuk Soon Choi, Gwang Ho Baik, Jeong Hoon Lee, Kyo Young Song, Saebeom Hur
The Korean Journal of Gastroenterology.2020; 75(6): 322. CrossRef
Guidelines for Nonvariceal Upper Gastrointestinal Bleeding
Joon Sung Kim, Byung-Wook Kim, Do Hoon Kim, Chan Hyuk Park, Hyuk Lee, Moon Kyung Joo, Da Hyun Jung, Jun- Won Chung, Hyuk Soon Choi, Gwang Ho Baik, Jeong Hoon Lee, Kyo Young Song, Saebeom Hur
Gut and Liver.2020; 14(5): 560. CrossRef
Síndrome de Mallory-Weiss: una complicación infrecuente en la preparación para una colonoscopia
Andrés Wonaga, Luis Viola
FMC - Formación Médica Continuada en Atención Primaria.2019; 26(2): 116. CrossRef
Overview of Mallory-Weiss syndrome
Kathleen Rich
Journal of Vascular Nursing.2018; 36(2): 91. CrossRef
Comparison of heater probe coagulation and argon plasma coagulation in the management of Mallory–Weiss tears and high-risk ulcer bleeding
Mete Akin, Erhan Alkan, Yasar Tuna, Tolga Yalcinkaya, Bulent Yildirim
Arab Journal of Gastroenterology.2017; 18(1): 35. CrossRef

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Clinical Features of Iatrogenic Mallory-Weiss Syndrome: In Key Choi, M.D., Sun Moon Kim, M.D., Jae Hyung Sun, M.D., Sang Yeol Cheon, M.D., Dae Seung Lim, M.D., Young Suk Kim, M.D., Tae Hee Lee, M.D., Euyi Hyeog Im, M.D., Kyu Chan Huh, M.D., Young Woo Choi, M.D. and Young Woo Kang, M.D.; Korean J Gastrointest Endosc 2009;39(2):72-77. Published online August 30, 2009

Abstract PDF: Background
/Aims: The detection of iatrogenic Mallory-Weiss syndrome during the course of upper GI endoscopy is apparently rare. The aim of this study was identify the clinical features of the disease and associated medical conditions.
Methods
We retrospectively analyzed 46 cases (0.08%) of iatrogenic Mallory- Weiss syndrome identified from 54,188 consecutive upper GI endoscopies performed at our institution during a period of 85 months.
Results
A total of 36 patients (78.2%) had retching or belching during the procedure. Hiatal hernias were noted in 20 patients (43.5%). We identified a difference of the attack rate by sex and age for iatrogenic Mallory-Weiss syndrome; the disorder developed predominantly in men. All of the patients had a mucosal tear and oozing and 16 patients underwent endoscopic hemostasis. After being diagnosed with iatrogenic Mallory-Weiss syndrome, 17 patients underwent follow- up endoscopy and all of the patients showed good results without rebleeding. No patient showed a complicated clinical course.
Conclusions
A small number of patients had iatrogenic Mallory-Weiss syndrome and most of the patients showed a good prognosis. If there is a predictable risk factor identified during an upper GI endoscopy or an associated medical condition, special care needs to be taken to minimize belching or retching. (Korean J Gastrointest Endosc 2009;39:72-77)

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A Gigantic Gastric Mucosal Rupture When Performing Endoscopy under Conscious Sedation in a Patient with Hiatal Hernia: Pyoung Rak Choi, M.D., Won Moon, M.D., Chan Bok Park, M.D., Eun Ho Park, M.D., Ji Suk Lee, M.D., Kyu Jong Kim, M.D., Moo In Park, M.D. and Seun Ja Park, M.D.; Korean J Gastrointest Endosc 2009;38(3):137-141. Published online March 30, 2009

Abstract PDF: Mallory-Weiss syndrome is a tear in the gastro-esophageal junction or its adjacent mucosa, and this occurs due to nausea or vomiting that is caused by various etiologic factors. It may occur in patients with excessive retching and struggling when undergoing upper gastrointestinal endoscopy, and its underlying factors are esophageal hiatal hernia, atrophic gastritis and old age. There are currently only rare reports about gigantic gastric mucosal rupture during performance of upper gastrointestinal endoscopy in patients with esophageal hiatal hernia. We recently experienced a 76-year-old woman who developed a gigantic gastric mucosal rupture that ranged from the gastro-esophageal junction to the gastric angle. This occurred during performance of standard upper gastrointestinal endoscopy with the patient under sedation and the patient had a concurrent esophageal hiatal hernia. The patient was treated conservatively for the rupture. Herein we report on our case along with a review of the relevant literature. (Korean J Gastrointest Endosc 2009;38:137-141)

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A Trial of Band Ligation Versus Epinephrine Injection in Actively Bleeding Mallory-Weiss Syndrome: Korean J Gastrointest Endosc 2003;27(5):398-398. Published online November 20, 2003

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A Study on Clinical Characteristics of Mallory-Weiss Syndrome with Complicated Course: Hang Lak Lee, M.D., Dong Soo Han, M.D., Jong Pyo Kim, M.D., Jin Bae Kim, M.D., Joon Yong Park, M.D., Joo Hyun Sohn, M.D. and Joon Soo Hahm, M.D.; Korean J Gastrointest Endosc 2003;26(6):405-409. Published online June 30, 2003

Abstract PDF: Background
/Aims: Mallory-Weiss syndrome is a benign and self-limiting disease, but occasionally cases with complications are encountered. The aim of this study was to identify the risk factors for complicated course and predisposing factors of Mallory-Weiss syndrome, and its associated conditions. Methods: Fifty-nine patients diagnosed as having Mallory-Weiss syndrome were subjects of this study. Patients' medical records were reviewed retrospectively. A complicated course was defined if there was a need for transfusion of ＞6 pints, evidence of shock, rebleeding or angiographic or surgical interventions. Results: Risk factors for a complicated Mallory-Weiss syndrome in univariate analysis were the followings; low hemoglobin, melena, presence of visible vessel or active bleeding on initial endoscopy. In multivariate analysis, the presence of visible vessel and active bleeding on initial endoscopy were the only significant risk factors. Predisposing factors of Mallory-Weiss syndrome were as follows: vomiting after alcohol intake (62.7%), vomiting without alcohol (18.6%), nausea (1%), cough (1%), seizure (1%) and unknown etiology (13.6%). Associated medical conditions were as follows: alcoholic liver disease (45.8%), hiatal hernia (27.1%) and liver cirrhosis (18.6%). Conclusions: We suggest that the presence of visible vessel and active bleeding on initial endoscopy are a independent risk factors of Mallory-Weiss syndrome with a complicated course. In such patients, aggressive treatment and careful observations are essential. (Korean J Gastrointest Endosc 2003;26:405⁣409)

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