Mallory-Weiss syndrome
ICD-10 K22.6 · ICD-11 DA26.3

Treatment of Mallory-Weiss Syndrome in Portal Hypertension and Gastric Varices

Clinical Scenario

This protocol addresses Mallory-Weiss syndrome in patients who also have portal hypertension or gastric varices — a combination that significantly changes the risk profile and the choice of hemostatic strategy.

The presence of portal hypertension or gastric varices introduces important constraints on standard endoscopic approaches. Thermal therapy is not recommended in this setting; band ligation is preferred when endoscopic hemostasis is pursued. For patients with portal hypertension or coagulopathy, intensive care including endoscopic hemostasis is recommended.
Treatment Approach

When standard endoscopic options are limited or unsuccessful in this setting, an angiographic intervention targeting the arterial supply is among the approaches considered to achieve hemorrhage control.

The full protocol specifies which angiographic techniques apply, the vascular targets involved, and the sequence of management steps.
Complete regimen — including intervention selection and procedural details — is available via the link below.
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.30574/gscarr.2025.23.3.0177
Thermal therapy is not recommended for Mallory-Weiss tears associated with portal hypertension or gastric varices; thus, band ligation is preferred.
For patients with risk factors such as portal hypertension or coagulopathy, intensive care including endoscopic hemostasis is recommended.
Angiographic interventions, such as injection of vasoconstrictor agents (e.g., vasopressin) or transcatheter embolization using gel foam, may be considered when endoscopy is unavailable or unsuccessful.
These approaches aim to obliterate the left gastric artery or superior mesenteric artery to control bleeding.
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