Mallory-Weiss Syndrome with Coronary Artery Disease: When Initial Management Fails to Achieve Hemostasis
This protocol applies to patients with Mallory-Weiss syndrome who have a history of coronary artery disease and in whom the initial treatment approach did not achieve hemostasis or resolution of symptoms.
Clinical Scenario
The patient has a documented history of coronary artery disease. This comorbidity is clinically significant because it directly determines which endoscopic hemostasis modalities are safe to use and which must be avoided.
Prior Line Failed — Escalation Trigger
The previous treatment — hemodynamic resuscitation per ABC protocols, intravenous access and fluid resuscitation, packed red blood cell transfusion where indicated, nasogastric decompression, correction of electrolyte and coagulation abnormalities, proton pump inhibitors or H2 receptor antagonists, and antiemetics including promethazine or ondansetron — did not achieve hemostasis or resolution of symptoms, triggering escalation to endoscopic intervention.
Next-Line Approach
Esophagogastroduodenoscopy (EGD) with endoscopic hemostasis is indicated — but the selection of modality is specifically guided by the patient's coronary artery disease history. The complete regimen, including which modalities apply and how they are sequenced in this setting, is in the full protocol.
References
DOI: 10.30574/gscarr.2025.23.3.0177
- In cases of ongoing or recurrent bleeding, various endoscopic modalities are available.
- These include local epinephrine injection for vasoconstriction, multipolar electrocoagulation (MPEC), sclerosing agent injection, contact heat treatment, argon plasma coagulation (APC), hemoclip placement, and band ligation, commonly used for bleeding Mallory-Weiss tears.
- However, due to systemic absorption, epinephrine may cause ventricular tachycardia, so it should be avoided in patients with a history of coronary artery disease.
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