Mallory-Weiss syndrome — mucosal laceration at the gastroesophageal junction — requires a fundamentally different management strategy when the patient has underlying portal hypertension or gastric varices. The presence of these conditions alters which haemostatic approaches are safe and appropriate.

Clinical scenario

This protocol applies to Mallory-Weiss syndrome occurring in patients with portal hypertension and gastric varices. Thermal haemostatic methods are not recommended in this context; the elevated vascular risk necessitates targeted endoscopic haemostasis and intensive monitoring from the outset.

Management approach

When earlier interventions have been exhausted, the protocol provides a surgical pathway — a last-resort option involving direct operative access to repair lacerations at the gastric cardia, as well as an endoscopy-guided laparoscopic alternative. The full sequence of decision points, the criteria for escalating to surgery, and all procedural details are contained in the complete protocol.

References

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.
Surgery is rarely required and is considered a last resort following failed endoscopic or angiographic interventions.
If no duodenal or gastric lesions are found, a wide gastrostomy is performed via laparotomy.
Mallory-Weiss lacerations at the gastric cardia are readily visible and can be repaired using running catgut sutures.
Endoscopy-guided laparoscopic suturing of the tear has demonstrated excellent outcomes.

DOI: 10.30574/gscarr.2025.23.3.0177

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

References