In patients with portal hypertension or gastric varices, Mallory-Weiss syndrome carries elevated bleeding risk and requires a specific approach to endoscopic hemostasis. When first-line resuscitation and pharmacologic measures do not achieve hemostasis and resolution of symptoms, this protocol defines the next step.
This protocol applies to patients with established portal hypertension or gastric varices. These comorbidities affect both bleeding severity and the selection of endoscopic technique. For patients with portal hypertension or coagulopathy, intensive care including endoscopic hemostasis is recommended.
The first-line approach — hemodynamic resuscitation following ABC protocols, intravenous access and fluid support, blood product transfusion when indicated, nasogastric decompression, correction of electrolyte imbalances and coagulation factors, and pharmacologic therapy with proton pump inhibitors or H2 receptor antagonists alongside antiemetics — may fail to achieve the goals of hemostasis and resolution of symptoms. When those targets are not met, escalation to endoscopic intervention is indicated.
Management centers on esophagogastroduodenoscopy (EGD) with endoscopic hemostasis. In the setting of portal hypertension or gastric varices, band ligation is the preferred modality — thermal therapy is not recommended in this context. Additional non-thermal endoscopic options are available when further intervention is required.
DOI: 10.30574/gscarr.2025.23.3.0177