Mallory Weiss syndrome is not associated with hiatal hernia: a matched case–control study

Corral, Juan E.; Keihanian, Tara; Kröner, Paul T.; Dauer, Ryan M.; Lukens, Frank; Sussman, Daniel A.

doi:10.1080/00365521.2016.1267793

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…Moreover, neither endoscopic findings of atrophic gastritis nor hiatal hernia were found in the 20 MWT patients. This was in accordance with a case-control study showing that hiatal hernia was not associated with MWT[22].…”

Section: Discussionsupporting

confidence: 93%

Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms

Chen¹,

Zhu²,

Wang³

et al. 2019

WJG

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BACKGROUNDAdverse 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.AIMTo investigate the incidence and risk factors of the MWT during esophageal ESD.METHODSFrom 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.RESULTSA 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.CONCLUSIONThe 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.

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Section: Discussionsupporting

confidence: 93%

Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms

Chen¹,

Zhu²,

Wang³

et al. 2019

WJG

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“…Hiatus hernia is discussed as a potential risk factor for MWS for decades and hiatus hernia is a common factor in reflux esophagitis 26–28 . Nevertheless, a more recent case-control study found no correlation between hiatal hernia and MWS 29 . In our study, there were 11,655 cases of diaphragmatic hernia (19.7% of all cases; 31.8% in the group with reflux esophagitis).…”

Section: Discussioncontrasting

confidence: 53%

A Systematic Analysis of Incidence, Therapeutic Strategies, and In-hospital Mortality of Mallory-Weiss Syndrome in Germany

Mertens,

Essing,

Roderburg

et al. 2023

Journal of Clinical Gastroenterology

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Background: Mallory-Weiss syndrome (MWS) is a rare cause of upper gastrointestinal bleeding from gaging or vomiting-induced mucosal lacerations at the gastroesophageal junction. Most cases do not require urgent endoscopic intervention due to the mostly self-limiting course. For more severe cases, different hemostasis techniques have been used. In small MWS cohorts, overall mortality was ~5%, but comprehensive data, as well as population-based incidence, treatment recommendations, and outcome parameters such as in-hospital mortality and adverse events, are largely lacking. Methods: We evaluated current epidemiological trends, therapeutic strategies, and in-hospital Mortality of MWS in Germany based on standardized hospital discharge data provided by the German Federal Statistical Office from 2010 to 2019. Results: A total of 59,291 MWS cases, predominately male (62%), were included into analysis. The mean number of MWS cases in Germany was 5929/year and decreased continuously during the observation period (−4.1%/y). The overall annual incidence rate (as hospitalization cases per 100,000 persons) was 7.5 with the highest incidence rate in the New Federal States (8.7). The most common comorbidities were reflux esophagitis (23.6%), diaphragmatic hernia (19.7%), and alcohol abuse (10.9%). The most frequent complication was bleeding anemia (26%), whereas hypovolemic shock (2.9%) was rare. Endoscopic injection was the most commonly performed endoscopic therapy (13.7%), followed by endoscopic clipping (12.8%), whereas the need for surgical therapy was rare (0.1%). Endoscopic combination therapies were used predominantly as a combination of injection and clipping. The overall in-hospital mortality was 2.7% and did not differ through the observation period. The presence of hypovolemic shock, acute kidney injury, sepsis, artificial ventilation, adult respiratory distress syndrome, bleeding anemia, and female sex was associated with a significantly worse prognosis. Conclusion: Our study gives a detailed insight into the incidence, patient-related risk factors, endoscopic treatment, and overall in-hospital mortality as well as regional differences in a large MWS collective in Germany. Furthermore, we were able to identify mortality-associated complications and their impact.

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“…Most cases of MWS are mild and may even go unnoticed. Large studies on MWS are scarce, with only 8 studies with over 100 cases in our literature review since 2000 [4, 12‒18]. A population-based study found 2,342 cases of MWS in 783,037 EGDs (0.3%), of which 421 (18%) has active bleeding [13].…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Large studies on MWS are scarce, with only 8 studies with over 100 cases in our literature review since 2000 [4, 12‒18]. A population-based study found 2,342 cases of MWS in 783,037 EGDs (0.3%), of which 421 (18%) has active bleeding [13]. Another study reported that 71 of 546 iatrogenic MWS (13%) required endoscopic hemostatic procedures [14].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Adenocarcinoma of the Gastroesophageal Junction Masquerading as Mallory-Weiss Syndrome

Okamoto

Fukuda

2022

Case Rep Gastroenterol

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Mallory-Weiss syndrome (MWS) is a relatively uncommon cause of upper gastrointestinal bleeding. While most cases can be managed conservatively, frequent transfusions or endoscopic hemostasis may be required in some cases. A 74-year-old man presented with hematemesis triggered by coughing. He had a history of violent chronic cough due to chronic obstructive pulmonary disease and was placed on aspirin and warfarin after multiple percutaneous coronary interventions and aortic valve replacement. Emergency esophagogastroduodenoscopy (EGD) revealed a mucosal tear in the gastroesophageal junction (GEJ) consistent with MWS which was treated with hemoclips. No tumor was seen at the bleeding site on follow-up EGD. Hematemesis after coughing was repeatedly seen 2–5 months after the initial episode. Twelve months after the initial episode, the patient was admitted for pneumonia, heart failure, and tarry stools. Emergent EGD revealed a 30-mm mass at the GEJ, diagnosed as poorly differentiated adenocarcinoma on biopsy. Computed tomography revealed multiple enlarged lymph nodes consistent with metastases. The patient died 1 week later due to unrelated acute respiratory distress syndrome. Endoscopists should be aware that cancer of the GEJ may masquerade as repeated episodes of MWS.

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Mallory Weiss syndrome is not associated with hiatal hernia: a matched case–control study

Abstract: Dynamic changes inducing mucosal tension are more relevant determinants to develop MWS than gastro-esophageal junction location alone.

Cited by 7 publications

References 5 publications

Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms

Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms

A Systematic Analysis of Incidence, Therapeutic Strategies, and In-hospital Mortality of Mallory-Weiss Syndrome in Germany

Adenocarcinoma of the Gastroesophageal Junction Masquerading as Mallory-Weiss Syndrome

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