MALLORY WEISS TEAR RELATED UPPER GI BLEEDING: AN INTERNATIONAL MULTICENTRE STUDY

Aims Mallory Weiss tears (MWT) are relatively uncommon causes of upper GI bleeding (UGIB). Patients with these lesions are generally considered at low risk of poor outcome, although data are relatively limited. There is also uncertainty about which patients with MWT require endoscopic therapy and which modality should be applied. We aimed to describe an international cohort of patients presenting with UGIB secondary to MWT.

Methods From an international dataset of patients undergoing endoscopy for acute UGIB at seven hospitals in UK, Denmark, Spain, USA, Singapore and New Zealand, we assessed those patients with MWT bleeding, including the endoscopic stigmata seen and endo-therapy applied. We compared baseline factors, rebleeding rates and 30-day mortality between patients with MWT, peptic ulcer bleeding (PUB) and all cause UGIB.

Results Out of a total of 3648 patients with UGIB, 125 (3.4%) had MWT related bleeding. MWT patients were younger (61 vs 69 years, p < 0.0001), more likely to be male (66 vs 53%, p = 0.006). Baseline heart rate (93 vs 90 bpm, p-value = 0.039) and haemoglobin (116 vs 90 g/L, p < 0.0001) were higher in MWT compared with PUB patients. Spurting blood, oozing of blood, or adherent clots, were seen in 6.4%, 26% and 24% MWTs respectively. 51 (41%) MWT patients received endo-therapy: 44 (86%) had adrenaline injection, 24 (47%) clips, and 5 (10%) thermal probe applied. 25 (20%) treated patients had combination endo-therapy. Although the rebleeding rate (4.9 vs 12%, p = 0.016) was lower in MWT patients compared with PUB patients, mortality was similar (5.7 vs 7.0%, p = 0.71).

Conclusions Although patients presenting with MWT were younger, with a lower rebleeding rate, their mortality was similar to that of patients with PUB. Endoscopic therapy was applied to 43% MWT patients, with adrenaline injection, followed by clips, the most common modalities employed.