Clinical Analysis Of 67 Cases Of Mallory-Weiss Syndrome

ObjectiveMallory-Weiss syndrome is one of the causes of upper gastrointestinal bleeding.The clinical features and endoscopic manifestations of 67 patients with MWS were analyzed retrospectively,and the predictive value of early risk score system AIMS65 and GBS for blood transfusion and endoscopic treatment in patients with MWS was compared,the clinical significance of endoscopic Forrest grading in MWS were explored,in order to provide timely and accurate risk assessment and treatment choice for MWS patients.MethodsA total of 67 MWS patients with complete clinical data were diagnosed by endoscopy because of gastrointestinal bleeding from January 2012 to January 2019 in the Digestive Department of the second affiliated Hospital of Suzhou University.We retrospectively analyzed the clinical features and endoscopic findings of these cases,and calculated the AIMS65 score and GBS score of the patients.Then the patients were divided into groups according to whether they received blood transfusion or endoscopic intervention.The receiver operating characteristic curve of the subjects with the two scoring methods were drawn to compare the area under the receiver operating characteristic curve between the two scoring methods,so as to evaluate the predictive value of the two scoring methods for blood transfusion and endoscopic intervention in patients with MWS.At the same time,the endoscopic manifestations of MWS patients were graded by Forrest grading system,and the guiding effect of Forrest grading on endoscopic treatment of MWS patients was discussed by calculating the area under ROC.Results1.Among the 67 patients,males accounted for the vast majority,and most of them were young and middle-aged.(1)Drinking alcohol accounted for the largest proportion of the inducement of onset,which was about 38.8%.(2)The typical clinical manifestation was gastrointestinal bleeding after nausea and vomiting,and 12 cases were accompanied with shock manifestations.(3)Endoscopic observation showed that 54 cases had a single longitudinal tear,and most of the tears were below the dentate line.19 cases of active bleeding,blood vessels exposed or fresh blood clots were found in the laceration under gastroscope,and all of them were treated under endoscope at the scene or on the same day.(4)In the clinical outcome,14 of all patients received blood transfusion and 19 received endoscopic treatment,including 2 cases of rebleeding and 1 case of death.2.According to the blood transfusion indications stipulated in the guidelines for the diagnosis and treatment of upper gastrointestinal bleeding,there were 14 cases in the blood transfusion group and 53 cases in the non-transfusion group,In terms of predicting blood transfusion,the AUC of AIMS65 score and GBS score were 0.670(95%CI 0.545-0.781,P=0.043)and 0.821(95%CI 0.708-0.904 P<0.001),respectively,but there was no significant difference in the area under the curve between the two scores(P=0.126).3.According to the manifestation of tear under gastroscope,19 patients received endoscopic treatment as endoscopic intervention group,and the remaining 48 patients were non-endoscopic intervention group.In terms of predicting endoscopic intervention,the AUC of AIMS65 score and GBS score were 0.583(95%CI 0.456-0.703,P=0.306)and 0.671(95%CI 0.545-0.781 P=0.019),respectively.4.The AUC of Forrest grading system for endoscopic treatment was 1.000(95%CI 0.946-1.000,P<0.001).The cut-off value is Forrest IIb(100%sensitivity,100%specificity)Conclusion1.Mallory-Weiss syndrome often occurs after drinking,but one quarte of patients is no obvious inducement;the main clinical manifestation is hematemesis or melene,and a few patients can have massive bleeding and even shock,which need timely blood transfusion and endoscopic intervention;if there are active bleeding,blood vessel exposure or fresh blood clots in the laceration,hemostatic treatment such as titanium clip or electrocoagulation is recommended.2.Both AIMS65 and GBS scores have good predictive ability for blood transfusion in patients with Mallory-Weiss syndrome;but in predicting endoscopic treatment,the predictive value of GBS is low,while the ability of AIMS65 is insufficient.3.Forrest grading system can be used to help determine the need for endoscopic intervention in patients with Mallory-Weiss syndrome,endoscopic hemostasis is recommended for patients with grade Forrest Ⅱb or above.