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Circumferential distribution and location of Mallory-Weiss tears: recent trends.

Okada M, Ishimura N, Shimura S, Mikami H, Okimoto E, Aimi M, Uno G, Oshima N, Yuki T, Ishihara S, Kinoshita Y - Endosc Int Open (2015)

Bottom Line: Risk factors for blood transfusion were a longer laceration (odds ratio [OR] 2.3) and a location extending from the esophagus to the stomach (OR 5.3).MWTs were frequently found on the right lateral wall (2 - to 4-o'clock position) of the esophagus aligned with the lesser curvature of the stomach, irrespective of etiology.Longer lacerations extending from the esophagus to the gastric cardia were associated with an elevated risk for bleeding and requirement for blood transfusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan.

ABSTRACT

Background and study aims: Mallory-Weiss tears (MWTs) are not only a common cause of acute nonvariceal gastrointestinal bleeding but also an iatrogenic adverse event related to endoscopic procedures. However, changes in the clinical characteristics and endoscopic features of MWTs over the past decade have not been reported. The aim of this study was to investigate recent trends in the etiology and endoscopic features of MWTs.

Patients and methods: We retrospectively reviewed the medical records of patients with a diagnosis of MWT at our university hospital between August 2003 and September 2013. The information regarding etiology, clinical parameters, endoscopic findings, therapeutic interventions, and outcome was reviewed.

Results: A total of 190 patients with MWTs were evaluated. More than half (n = 100) of the cases occurred during endoscopic procedures; cases related to alcohol consumption were less frequent (n = 13). MWTs were most frequently located in the lesser curvature of the stomach and right lateral wall (2 - to 4-o'clock position) of the esophagus, irrespective of the cause. The condition of more than 90 % of the patients (n = 179) was improved by conservative or endoscopic treatment, whereas 11 patients (5.8 %) required blood transfusion. Risk factors for blood transfusion were a longer laceration (odds ratio [OR] 2.3) and a location extending from the esophagus to the stomach (OR 5.3).

Conclusions: MWTs were frequently found on the right lateral wall (2 - to 4-o'clock position) of the esophagus aligned with the lesser curvature of the stomach, irrespective of etiology. Longer lacerations extending from the esophagus to the gastric cardia were associated with an elevated risk for bleeding and requirement for blood transfusion.

No MeSH data available.


Related in: MedlinePlus

 Circumferential distribution of Mallory-Weiss tears in patients (a) with and (b) without endoscopic procedures. Mallory-Weiss tears were frequently located in the right lateral wall (2- to 4-o’clock position) at the esophagogastric junction in both groups. A, anterior wall; P, posterior wall; R, right lateral wall; L, left lateral wall.
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FI220-3:  Circumferential distribution of Mallory-Weiss tears in patients (a) with and (b) without endoscopic procedures. Mallory-Weiss tears were frequently located in the right lateral wall (2- to 4-o’clock position) at the esophagogastric junction in both groups. A, anterior wall; P, posterior wall; R, right lateral wall; L, left lateral wall.

Mentions: The clinical and endoscopic characteristics of the patients with and without iatrogenic MWT are shown in Table 4. The mean age was significantly higher in the patients with iatrogenic MWT. Most patients had a single laceration, and multiple lacerations were rare among the patients with iatrogenic MWT (P = 0.02). Localized gastric lesions were more frequent in the patients with endoscopic procedure-related MWT, whereas esophagogastric lesions were more frequent in the patients with other types of MWT (P < 0.001). Lacerations tended to be located in the right lateral wall (2 – to 4-o’clock position) in both the patients with iatrogenic MWT and those with MWT of other causes (Fig. 3).


Circumferential distribution and location of Mallory-Weiss tears: recent trends.

Okada M, Ishimura N, Shimura S, Mikami H, Okimoto E, Aimi M, Uno G, Oshima N, Yuki T, Ishihara S, Kinoshita Y - Endosc Int Open (2015)

 Circumferential distribution of Mallory-Weiss tears in patients (a) with and (b) without endoscopic procedures. Mallory-Weiss tears were frequently located in the right lateral wall (2- to 4-o’clock position) at the esophagogastric junction in both groups. A, anterior wall; P, posterior wall; R, right lateral wall; L, left lateral wall.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612247&req=5

FI220-3:  Circumferential distribution of Mallory-Weiss tears in patients (a) with and (b) without endoscopic procedures. Mallory-Weiss tears were frequently located in the right lateral wall (2- to 4-o’clock position) at the esophagogastric junction in both groups. A, anterior wall; P, posterior wall; R, right lateral wall; L, left lateral wall.
Mentions: The clinical and endoscopic characteristics of the patients with and without iatrogenic MWT are shown in Table 4. The mean age was significantly higher in the patients with iatrogenic MWT. Most patients had a single laceration, and multiple lacerations were rare among the patients with iatrogenic MWT (P = 0.02). Localized gastric lesions were more frequent in the patients with endoscopic procedure-related MWT, whereas esophagogastric lesions were more frequent in the patients with other types of MWT (P < 0.001). Lacerations tended to be located in the right lateral wall (2 – to 4-o’clock position) in both the patients with iatrogenic MWT and those with MWT of other causes (Fig. 3).

Bottom Line: Risk factors for blood transfusion were a longer laceration (odds ratio [OR] 2.3) and a location extending from the esophagus to the stomach (OR 5.3).MWTs were frequently found on the right lateral wall (2 - to 4-o'clock position) of the esophagus aligned with the lesser curvature of the stomach, irrespective of etiology.Longer lacerations extending from the esophagus to the gastric cardia were associated with an elevated risk for bleeding and requirement for blood transfusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan.

ABSTRACT

Background and study aims: Mallory-Weiss tears (MWTs) are not only a common cause of acute nonvariceal gastrointestinal bleeding but also an iatrogenic adverse event related to endoscopic procedures. However, changes in the clinical characteristics and endoscopic features of MWTs over the past decade have not been reported. The aim of this study was to investigate recent trends in the etiology and endoscopic features of MWTs.

Patients and methods: We retrospectively reviewed the medical records of patients with a diagnosis of MWT at our university hospital between August 2003 and September 2013. The information regarding etiology, clinical parameters, endoscopic findings, therapeutic interventions, and outcome was reviewed.

Results: A total of 190 patients with MWTs were evaluated. More than half (n = 100) of the cases occurred during endoscopic procedures; cases related to alcohol consumption were less frequent (n = 13). MWTs were most frequently located in the lesser curvature of the stomach and right lateral wall (2 - to 4-o'clock position) of the esophagus, irrespective of the cause. The condition of more than 90 % of the patients (n = 179) was improved by conservative or endoscopic treatment, whereas 11 patients (5.8 %) required blood transfusion. Risk factors for blood transfusion were a longer laceration (odds ratio [OR] 2.3) and a location extending from the esophagus to the stomach (OR 5.3).

Conclusions: MWTs were frequently found on the right lateral wall (2 - to 4-o'clock position) of the esophagus aligned with the lesser curvature of the stomach, irrespective of etiology. Longer lacerations extending from the esophagus to the gastric cardia were associated with an elevated risk for bleeding and requirement for blood transfusion.

No MeSH data available.


Related in: MedlinePlus