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1.
Leg Med (Tokyo) ; 66: 102367, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38039656

RESUMO

Gastric tears are rarely described in the forensic pathological literature, although they can lead to a fatal acute exsanguination. Such lesions can arise from several conditions leading to an increased intragastric pressure, such as Mallory Weiss syndrome, cardiopulmonary resuscitation, acute barotrauma and operative procedures, showing peculiar morphological features. We present a case of a 32-year-old drug addicted white woman found dead in a pool of blood in the house of her drug dealer, after taking a dose of intravenous heroin. At autopsy, abundant bloody gastric content and multiple and long gastric tears, extending from the cardias and fundus regions to the gastric corpus were observed; one of them involved the subserous region, resulting in a gastric wall rupture. The victim had no history of recent vomiting and of gastro-intestinal pathologies. Drugs and ethanol levels detected in the specimens of the victim were not consistent with lethal concentrations, thus the death was attributed to acute exsanguination. After reviewing the literature, it turned out that morphological aspects of the gastric tears, such as number, size and topographical distribution, observed at autopsy were atypical compared to those of typical gastric lacerations.


Assuntos
Lacerações , Síndrome de Mallory-Weiss , Humanos , Feminino , Adulto , Exsanguinação/patologia , Estômago/patologia , Síndrome de Mallory-Weiss/patologia , Autopsia
2.
BMC Nephrol ; 24(1): 188, 2023 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-37365498

RESUMO

BACKGROUND: Hemodialysis 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 PRESENTATION: In 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. CONCLUSIONS: We 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.


Assuntos
Síndrome de Mallory-Weiss , Humanos , Tratamento Conservador/efeitos adversos , Morte , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Síndrome de Mallory-Weiss/complicações , Síndrome de Mallory-Weiss/diagnóstico , Vômito , Adolescente , Pessoa de Meia-Idade , Idoso , Masculino , Feminino
3.
Medicine (Baltimore) ; 101(31): e29636, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35945721

RESUMO

RATIONALE: Upper gastrointestinal hemorrhage (UGIH) is defined as hemorrhage originating from the gastrointestinal tract proximal to the ligament of Treitz. The causes of UGIH include esophagitis, gastritis, peptic ulcers, Mallory-Weiss syndrome, and cancer. However, a rare cause of UGIH, such as an accessory spleen, may lead to serious complications if left untreated and can sometimes be very difficult to diagnose preoperatively. PATIENT CONCERNS: An 18-year-old man was admitted to the Department of Gastroenterology of our hospital due to "repeated black stool for 2 months with aggravation, accompanied by hematemesis for 9 days." He denied any history of hepatitis, trauma, or surgery. DIAGNOSIS: Laboratory evaluation revealed severe anemia (hemoglobin, 6.4 g/dL). Computed tomography revealed a mass measuring 127 mm in its largest dimension, located in the upper left abdomen, with varicose veins in the gastric fundus. Moreover, distended blue-purple tortuous veins were observed by gastroscopy in the gastric fundus. We believed the mass was likely an abnormally proliferating accessory spleen; however, the causes of severe anemia and gastrointestinal hemorrhage were unknown. INTERVENTIONS: After discussion in a multidisciplinary conference, the mass was completely resected laparoscopically, and the subserosal veins in the gastric fundus were sutured using absorbable threads. OUTCOMES: After the surgery, the patient recovered uneventfully without any complications. Clinicopathological examination showed that the mass was chronic congestive splenomegaly. Gastrointestinal hemorrhage secondary to an abnormally proliferating accessory spleen was confirmed as the diagnosis. Laboratory evaluation revealed hemoglobin at 12.1 g/dL 2 months after surgery. At the 12-month follow-up, the patient showed no recurrence of gastrointestinal hemorrhage. LESSONS: UGIH caused by accessory spleen is extremely rare. This entity should be considered in differential diagnosis of gastrointestinal hemorrhage. Surgical intervention is necessary for timely diagnosis and treatment in case of gastrointestinal hemorrhage in critical clinical situations.


Assuntos
Anormalidades do Sistema Digestório , Síndrome de Mallory-Weiss , Esplenopatias , Adolescente , Anormalidades do Sistema Digestório/complicações , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Hematemese/etiologia , Humanos , Masculino , Síndrome de Mallory-Weiss/complicações , Esplenopatias/complicações
4.
Cir Cir ; 89(S2): 26-30, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932533

RESUMO

Spontaneous lesions can affect only a part of the esophageal wall (Mallory-Weiss syndrome) or constitute a full-thickness rupture of the organ, leading to Boerhaave syndrome. Most commonly affecting males between 50 and 70 years of age, Clinically, the Mackler triad is vomiting, severe chest pain, and subcutaneous cervical emphysema. The delay in diagnosis explains the high mortality rate of this pathology up to 40-60% in those treated at 48 hours. The prognosis improves if treatment is established within the first 24 hours.


Las lesiones espontáneas pueden afectar solo una parte de la pared esofágica (síndrome de Mallory-Weiss) o constituir una rotura de espesor total del órgano, dando lugar al síndrome de Boerhaave. Afecta con mayor frecuencia a los varones entre 50 y 70 años de edad. Clínicamente conforma la tríada de Mackler: vómito, dolor torácico intenso y enfisema subcutáneo cervical. El retraso en el diagnóstico explica su alta tasa de mortalidad, de hasta el 40-60% en los pacientes tratados a las 48 horas. El pronóstico mejora si se logra instaurar el tratamiento dentro de las primeras 24 horas.


Assuntos
Perfuração Esofágica , Síndrome de Mallory-Weiss , Doenças do Mediastino , Idoso , Dor no Peito , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Humanos , Masculino , Doenças do Mediastino/diagnóstico por imagem , Ruptura Espontânea
5.
Nihon Shokakibyo Gakkai Zasshi ; 117(11): 985-991, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33177261

RESUMO

An 86-year-old man was transferred to the Tokyo Medical University Hospital because of a temporary loss of consciousness and melena. We performed upper gastrointestinal endoscopy, which revealed Mallory-Weiss syndrome caused by a strong vomiting reflex. After an examination, he complained of abdominal pain, and his blood pressure decreased. Abdominal contrast-enhanced computed tomography showed fresh intra-abdominal hemorrhage. We performed transcatheter arterial embolization by using N-butyl-2-cyanoacrylate to control the bleeding from the right gastroepiploic artery. Intra-abdominal hemorrhage after upper gastrointestinal endoscopy is rare, and we report this case with the literature review.


Assuntos
Embolização Terapêutica , Embucrilato , Síndrome de Mallory-Weiss , Idoso de 80 Anos ou mais , Endoscopia do Sistema Digestório , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hemoperitônio , Humanos , Masculino
6.
Am Fam Physician ; 101(5): 294-300, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32109037

RESUMO

Upper gastrointestinal (GI) bleeding is defined as hemorrhage from the mouth to the ligament of Treitz. Common risk factors for upper GI bleeding include prior upper GI bleeding, anticoagulant use, high-dose nonsteroidal anti-inflammatory drug use, and older age. Causes of upper GI bleeding include peptic ulcer bleeding, gastritis, esophagitis, variceal bleeding, Mallory-Weiss syndrome, and cancer. Signs and symptoms of upper GI bleeding may include abdominal pain, lightheadedness, dizziness, syncope, hematemesis, and melena. Physical examination includes assessment of hemodynamic stability, presence of abdominal pain or rebound tenderness, and examination of stool color. Laboratory tests should include a complete blood count, basic metabolic panel, coagulation panel, liver tests, and type and crossmatch. A bolus of normal saline or lactated Ringer solution should be rapidly infused to correct hypovolemia and to maintain blood pressure, and blood should be transfused when hemoglobin is less than 7 g per dL. Clinical prediction guides (e.g., Glasgow-Blatchford bleeding score) are necessary for upper GI bleeding risk stratification and to determine therapy. Patients with hemodynamic instability and signs of upper GI bleeding should be offered urgent endoscopy, performed within 24 hours of presentation. A common strategy in patients with failed endoscopic hemostasis is to attempt transcatheter arterial embolization, then proceed to surgery if hemostasis is not obtained. Proton pump inhibitors should be initiated upon presentation with upper GI bleeding. Guidelines recommend high-dose proton pump inhibitor treatment for the first 72 hours post-endoscopy because this is when rebleeding risk is highest. Deciding when to restart antithrombotic therapy after upper GI bleeding is difficult because of lack of sufficient data.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Adulto , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/efeitos adversos , Anticoagulantes/efeitos adversos , Transfusão de Sangue , Endoscopia Gastrointestinal , Fibrinolíticos/uso terapêutico , Gastroenterite/complicações , Hemorragia Gastrointestinal/etiologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Humanos , Síndrome de Mallory-Weiss/complicações , Úlcera Péptica/complicações , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Bomba de Prótons/uso terapêutico , Fatores de Risco , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos
7.
World J Gastroenterol ; 25(34): 5174-5184, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31558865

RESUMO

BACKGROUND: Adverse events during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, the Mallory-Weiss Tear (MWT) during esophageal ESD remains under investigation. AIM: To investigate the incidence and risk factors of the MWT during esophageal ESD. METHODS: From June 2014 to July 2017, patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed. The clinicopathological characteristics of the patients were collected. Patients were divided into an MWT group and non-MWT group based on whether MWT occurred during ESD. The incidence of MWTs was determined, and the risk factors for MWT were then further explored. RESULTS: A total of 337 patients with 373 lesions treated by ESD were analyzed. Twenty patients developed MWTs during ESD (5.4%). Multivariate analysis identified that female sex (OR = 5.36, 95%CI: 1.47-19.50, P = 0.011) and procedure time longer than 88.5 min (OR = 3.953, 95%CI: 1.497-10.417, P = 0.005) were independent risk factors for an MWT during ESD. The cutoff value of the procedure time for an MWT was 88.5 min (sensitivity, 65.0%; specificity, 70.8%). Seven of the MWT patients received endoscopic hemostasis. All patients recovered satisfactorily without surgery for the laceration. CONCLUSION: The incidence of MWTs during esophageal ESD was much higher than expected. Although most cases have a benign course, fatal conditions may occur. We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region.


Assuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Neoplasias Esofágicas/cirurgia , Esofagoscopia/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Síndrome de Mallory-Weiss/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Mucosa Esofágica/diagnóstico por imagem , Mucosa Esofágica/patologia , Mucosa Esofágica/cirurgia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Incidência , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Masculino , Síndrome de Mallory-Weiss/diagnóstico por imagem , Síndrome de Mallory-Weiss/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
8.
Medicine (Baltimore) ; 98(22): e15751, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145291

RESUMO

Mallory-Weiss syndrome (MWS) is a relatively less common cause of nonvariceal upper gastrointestinal bleeding. There is limited data on whether scoring systems could be used to predict the clinical outcomes in patients with bleeding due to MWS. The aim of our study is to evaluate whether the Glasgow-Blatchford score (GBS), AIMS65, and shocking index are effective in predicting the clinical outcomes of MWS.One hundred twenty-eight patients from January 2010 to January 2017 with MWS in middle China were enrolled. Clinical features such as age, gender, causes of vomiting, endoscopic findings, GBS, AIMS65, and shocking index were recorded. The clinical outcomes including endoscopic treatment and transfusion were analyzed.MWS accounted for 6.1% of nonvariceal upper gastrointestinal bleeding. Male-to-female ratio was 3.6:1 and median age was 51 years. Patients between 40 and 60 years were more commonly affected; 43.8% of MWS was caused by overdrinking followed by underlying gastric diseases (33.6%). However, for female patients alone, underlying gastric diseases were the leading cause (42.9%). The tears were usually single and most frequently located on the left lateral wall. In receiver-operating characteristic curve analyses, GBS system and shocking index were useful in predicting transfusion (0.856 vs 0.675). But for endoscopic intervention, these scoring systems are not helpful (P > .05).Apart from drinking, underlying gastric disease is another important cause of MWS especially for female patients and should be paid more attention under endoscopy examination. GBS system and shocking index can be used to predict transfusion.


Assuntos
Hemorragia Gastrointestinal/patologia , Síndrome de Mallory-Weiss/patologia , Medição de Risco/métodos , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Criança , Pré-Escolar , Endoscopia , Feminino , Hemorragia Gastrointestinal/etiologia , Escala de Resultado de Glasgow , Humanos , Lactente , Masculino , Síndrome de Mallory-Weiss/complicações , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Adulto Jovem
10.
Eur J Gastroenterol Hepatol ; 31(7): 781-785, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31008809

RESUMO

OBJECTIVE: Risk assessment in nonvariceal upper gastrointestinal bleeding (UGIB) is not well validated and remains unclear in hemodynamically stable patients at emergency department admission. We compared the prognostic value of risk-scoring systems for predicting adverse outcomes in patients with nonvariceal UGIB and normotension. PARTICIPANTS AND METHODS: A single-center prospective observational study was carried out. Patients with consecutive nonvariceal UGIB, presenting with normotension (systolic blood pressure ≥90 mmHg) to the emergency department, were included. We compared the areas under the curves (AUC) of Glasgow Blatchford score (GBS), the pre-endoscopy Rockall score, AIMS65, the shock index, and the modified shock index with respect to adverse outcomes defined as embolization, surgery, ICU admission, rebleeding, and in-hospital mortality. RESULTS: In total, 1233 patients were included. Adverse outcomes occurred in 165 (13.4%) patients; in-hospital mortality was 1.2%. AUC of the GBS for adverse outcome was higher than that of the shock index, but not significantly different (0.647 vs. 0.569, P=0.23). AUC values of the modified shock index, AIMS65, and the pre-endoscopy Rockall score were 0.565, 0.593, and 0.533, respectively. The cut-off value of the GBS (≥8) was associated with 85% sensitivity and 35% specificity for predicting adverse outcome. CONCLUSION: Pre-existing risk scores have shown suboptimal predictive ability for adverse events in normotensive patients with nonvariceal UGIB. The GBS (≥8) might help to identify patients prone to adverse events; however, further studies with risk scores or new scores are needed because of the low accuracy of these scores.


Assuntos
Duodenopatias/terapia , Embolização Terapêutica/estatística & dados numéricos , Doenças do Esôfago/terapia , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Gastropatias/terapia , Idoso , Transfusão de Sangue , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Úlcera Duodenal , Serviço Hospitalar de Emergência , Endoscopia do Sistema Digestório/métodos , Esofagite/complicações , Feminino , Gastrite/complicações , Hemorragia Gastrointestinal/etiologia , Neoplasias Gastrointestinais/complicações , Humanos , Masculino , Síndrome de Mallory-Weiss/complicações , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/terapia , Recidiva , Medição de Risco , Úlcera Gástrica , Trato Gastrointestinal Superior
13.
Medicine (Baltimore) ; 97(49): e13191, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30544378

RESUMO

RATIONALE: Spontaneous esophageal rupture (Boerhaave syndrome) is a rare, though frequently fatal, event. It is generally caused by a sudden increase in pressure inside the esophagus. In some cases, full-thickness perforations of the esophagus may develop from previous lesions that initially involve only the esophageal mucosa (Mallory-Weiss syndrome) and which, following further triggering events, give rise to a transmural lesion. PATIENT CONCERNS: Here, we present the case of a 45-year-old subject who suddenly died of acute cardio-respiratory failure, an autopsy was performed to identify the cause of death. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: The autopsy examination revealed a full-thickness rupture of the esophageal wall. Through the integration of necroscopy findings, anamnestic data, and histopathological examination, it has been possible to establish that complete esophageal rupture resulted from the evolution of a previous partial lesion of the esophageal wall, and that an untreated Mallory-Weiss syndrome evolved into a rapidly fatal Boerhaave syndrome. LESSONS: This case shows that distal esophageal tears, rather than constituting a distinct entity, may be part of a spectrum of diseases and that a partial lesion of the esophageal wall caused by barogenic injury may evolve into a full-thickness rupture following further barotraumas.


Assuntos
Perfuração Esofágica/etiologia , Perfuração Esofágica/patologia , Síndrome de Mallory-Weiss/complicações , Síndrome de Mallory-Weiss/patologia , Doenças do Mediastino/etiologia , Doenças do Mediastino/patologia , Morte Súbita , Progressão da Doença , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade
14.
Dig Dis Sci ; 63(12): 3253-3261, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30132232

RESUMO

BACKGROUND AND AIMS: Compared with ulcer bleeding (UB) in non-variceal upper gastrointestinal bleeding (NVUGIB), non-ulcer bleeding (NUB) is often considered to have a low risk of poor outcomes and is treated less intensively without any risk stratification. We conducted this study to assess the predictability of scoring systems for NUB and compare the outcomes of NUB and UB. METHODS: A total of 1831 UGIB patients were registered in the database during the period from February 2011 to December 2013. Among them, 1424 patients with NVUGIB were divided into two groups: Group UB (1101 patients with peptic ulcer bleeding) and Group NUB (323 patients with non-peptic ulcer-related bleeding). RESULTS: The most common cause of bleeding in Group NUB was Mallory-Weiss tears (51.1%), followed by Dieulafoy lesions (18.9%). A receiver operating characteristic (ROC) analysis revealed that the pre-Rockall score [area under the ROC (AUROC) = 0.798; 95% CI 0.707-0.890] and full Rockall score (AUROC = 0.794; 95% CI 0.693-0.895) were relatively good at predicting overall mortality in NUB. Glasgow-Blatchford score (AUROC = 0.783; 95% CI 0.730-0.836) was the most closely correlated with the need for clinical intervention in NUB. Those who had Glasgow-Blatchford score of 0 did not require any interventions, including blood transfusions. There were no statistical differences in overall mortality (p = 0.387), bleeding-related mortality (p = 0.447), or the incidence of re-bleeding (p = 0.117) between the two groups. CONCLUSIONS: Scoring systems are useful to predict mortality and the need for clinical intervention in patients with NUB.


Assuntos
Hemorragia Gastrointestinal , Síndrome de Mallory-Weiss , Úlcera Péptica , Bases de Dados Factuais , Endoscopia Gastrointestinal/estatística & dados numéricos , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Humanos , Masculino , Síndrome de Mallory-Weiss/complicações , Síndrome de Mallory-Weiss/diagnóstico , Síndrome de Mallory-Weiss/epidemiologia , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Úlcera Péptica/complicações , Úlcera Péptica/diagnóstico , Úlcera Péptica/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Curva ROC , República da Coreia/epidemiologia , Projetos de Pesquisa/estatística & dados numéricos , Medição de Risco/métodos , Fatores de Risco , Análise de Sobrevida
16.
Dis Mon ; 64(7): 333-343, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29525375

RESUMO

Non-variceal upper gastrointestinal bleeding continues to be an important cause of morbidity and mortality. The most common causes include peptic ulcer disease, Mallory-Weiss syndrome, erosive gastritis, duodenitis, esophagitis, malignancy, angiodysplasias and Dieulafoy's lesion. Initial assessment and early aggressive resuscitation significantly improves outcomes. Upper gastrointestinal endoscopy continues to be the gold standard for diagnosis and treatment. We present a comprehensive review of literature for the evaluation and management of non-variceal upper gastrointestinal bleeding.


Assuntos
Duodenite/complicações , Esofagoscopia , Gastrite/complicações , Hemorragia Gastrointestinal , Gastroscopia , Síndrome de Mallory-Weiss/complicações , Úlcera Péptica/complicações , Anticoagulantes/uso terapêutico , Transfusão de Sangue/métodos , Embolização Terapêutica/métodos , Neoplasias Esofágicas/complicações , Esofagite/complicações , Esofagoscopia/métodos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Gastroscopia/métodos , Humanos , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Neoplasias Gástricas/complicações , Resultado do Tratamento , Trato Gastrointestinal Superior/patologia
17.
Arab J Gastroenterol ; 18(1): 35-38, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28262530

RESUMO

BACKGROUND AND STUDY AIMS: Upper gastrointestinal (GI) bleeding is a common medical emergency. Endoscopic treatments often lead to better therapeutic outcomes than conventional conservative treatments. This study aimed to investigate and compare the use of heater probe coagulation (HPC) and argon plasma coagulation (APC) together with epinephrine injection for the treatment of Mallory-Weiss tears and high-risk ulcer bleeding. PATIENTS AND METHODS: A total of 97 patients (54 in the HPC group and 43 in the APC group) who were diagnosed with upper GI bleeding secondary to a Mallory-Weiss tear or high-risk gastric or duodenal ulcers were included in the study. Lesions were classified according to the Forrest classification. The HPC and APC groups were compared in terms of initial haemostasis, re-bleeding in the early period, need for surgery, average need for transfusion, and duration of hospital stay. RESULTS: There were no significant differences between the HPC and APC groups in terms of ensuring initial haemostasis (98% vs. 97.5%, p>0.05), re-bleeding rates (17% vs. 19%, p>0.05), need for surgery (2% vs. 9%, p>0.05), average need for transfusion (3.7±2.11 vs. 3.4±2.95 units, p>0.05), and average duration of hospital stay (4.6±2.24vs. 5.3±3.23days, p>0.05). CONCLUSION: There was no difference between HPC and APC when used together with epinephrine injection for the treatment of Mallory-Weiss tear and high-risk ulcer bleeding.


Assuntos
Coagulação com Plasma de Argônio/métodos , Ablação por Cateter/métodos , Úlcera Duodenal/complicações , Síndrome de Mallory-Weiss/cirurgia , Úlcera Péptica Hemorrágica/cirurgia , Úlcera Gástrica/complicações , Endoscopia Gastrointestinal , Epinefrina/administração & dosagem , Feminino , Seguimentos , Humanos , Injeções Intralesionais , Masculino , Síndrome de Mallory-Weiss/complicações , Síndrome de Mallory-Weiss/diagnóstico , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Vasoconstritores/administração & dosagem
18.
Gastroenterology ; 152(6): 1310-1318.e1, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28167214

RESUMO

BACKGROUND & AIMS: For 4 decades, stigmata of recent hemorrhage in patients with nonvariceal lesions have been used for risk stratification and endoscopic hemostasis. The arterial blood flow that underlies the stigmata rarely is monitored, but can be used to determine risk for rebleeding. We performed a randomized controlled trial to determine whether Doppler endoscopic probe monitoring of blood flow improves risk stratification and outcomes in patients with severe nonvariceal upper gastrointestinal hemorrhage. METHODS: In a single-blind study performed at 2 referral centers we assigned 148 patients with severe nonvariceal upper gastrointestinal bleeding (125 with ulcers, 19 with Dieulafoy's lesions, and 4 with Mallory Weiss tears) to groups that underwent standard, visually guided endoscopic hemostasis (control, n = 76), or endoscopic hemostasis assisted by Doppler monitoring of blood flow under the stigmata (n = 72). The primary outcome was the rate of rebleeding after 30 days; secondary outcomes were complications, death, and need for transfusions, surgery, or angiography. RESULTS: There was a significant difference in the rates of lesion rebleeding within 30 days of endoscopic hemostasis in the control group (26.3%) vs the Doppler group (11.1%) (P = .0214). The odds ratio for rebleeding with Doppler monitoring was 0.35 (95% confidence interval, 0.143-0.8565) and the number needed to treat was 7. CONCLUSIONS: In a randomized controlled trial of patients with severe upper gastrointestinal hemorrhage from ulcers or other lesions, Doppler probe guided endoscopic hemostasis significantly reduced 30-day rates of rebleeding compared with standard, visually guided hemostasis. Guidelines for nonvariceal gastrointestinal bleeding should incorporate these results. ClinicalTrials.gov no: NCT00732212 (CLIN-013-07F).


Assuntos
Endossonografia , Hemostase Endoscópica/métodos , Síndrome de Mallory-Weiss/terapia , Úlcera Péptica Hemorrágica/terapia , Ultrassonografia Doppler , Malformações Vasculares/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Síndrome de Mallory-Weiss/diagnóstico por imagem , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/diagnóstico por imagem , Recidiva , Fluxo Sanguíneo Regional , Medição de Risco/métodos , Índice de Gravidade de Doença , Método Simples-Cego , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem
19.
Scand J Gastroenterol ; 52(4): 462-464, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28007004

RESUMO

BACKGROUND/OBJECTIVE: Hiatal hernia is considered to be a predisposing factor to develop Mallory-Weiss Syndrome (MWS). No large case-control studies verifying this hypothesis have been conducted. METHODS: We reviewed all esophagogastroduodenoscopies with findings of MWS (n = 2342) in a national database and compared with age and gender-matched controls (n = 9368). Demographics, endoscopic characteristics and presence of a hiatal hernia were compared between both groups. Average age was 56.7 ± 18.6 years, and 72.4% were male. RESULTS: Hiatal hernia was more common in controls, and no significant difference was seen in a multivariate analysis. CONCLUSION: Dynamic changes inducing mucosal tension are more relevant determinants to develop MWS than gastro-esophageal junction location alone.


Assuntos
Hemorragia Gastrointestinal/etiologia , Hérnia Hiatal/epidemiologia , Síndrome de Mallory-Weiss/complicações , Adulto , Idoso , Estudos de Casos e Controles , Bases de Dados Factuais , Endoscopia do Sistema Digestório , Junção Esofagogástrica/patologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mucosa/patologia , Análise Multivariada , Estados Unidos
20.
J Dig Dis ; 17(10): 676-684, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27624697

RESUMO

OBJECTIVES: There is limited data on whether scoring systems can be used to predict clinical outcomes in patients with upper gastrointestinal bleeding due to Mallory-Weiss syndrome (MWS). We aimed to evaluate whether the Glasgow-Blatchford score (GBS) could be effective in predicting clinical outcomes of bleeding MWS and to investigate the predictive ability of the Forrest classification for rebleeding and assess the effective endoscopic modalities for bleeding control in MWS. METHODS: From January 2004 to December 2012 168 patients were diagnosed with MWS in the Asan Medical Center Emergency Department. We analyzed their clinical outcomes, including endoscopic treatment, transfusion and admission as well as the rates of rebleeding and mortality using GBS and the Forrest classification, retrospectively. RESULTS: Endoscopic treatment was applied to patients. The GBS was significantly higher in patients treated with endoscopic therapy than in the conservative treatment group (6.8 ± 3.7 vs 5.1 ± 4.7, P = 0.011). In patients with a GBS of >6 the rates of endoscopic treatment and rebleeding and the need for transfusion and admission were significantly higher (all P < 0.05). The Forrest classification was able to predict recurrent bleeding (area under the receiver operating characteristic curve 0.723, 95% confidence interval 0.609-0.836, P = 0.025). Hemoclip-based therapy and band ligation achieved higher success rates than did injection therapy alone in preventing rebleeding (96.4%, 88.9% and 71.4%, P = 0.013). CONCLUSION: In MWS, GBS might be useful for predicting clinical outcomes and the Forrest classification in predicting recurrent bleeding.


Assuntos
Esofagoscopia/métodos , Síndrome de Mallory-Weiss/diagnóstico , Síndrome de Mallory-Weiss/cirurgia , Índice de Gravidade de Doença , Adulto , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Síndrome de Mallory-Weiss/complicações , Pessoa de Meia-Idade , Prognóstico , Recidiva , Fatores de Risco , Resultado do Tratamento
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