Efficacy and Safety of Mono-polar Coagulation Forceps in the Repair of Large Mallory-Weiss Tear in Patients with Massive Upper Gastrointestinal Bleeding, 2 Case Reports

Mallory-Weiss tear (MWT) is a frequent cause of acute upper gastrointestinal (AUGI) bleeding and is defined as a longitudial superficial mucosal tear that usually occurs at the gastroesophageal junction. MWT is usually associated with increased abdominal pressure. 50 to 70% of patients diagnosed with MWT have a history of heavy alcohol intake. MWT usually presents with bright red or coffee-ground vomitus, black tar-like stool, signs of anemia, chest pain, abdominal pain, or signs of shock. Bleeding from MWT can stop on its own, however, significant bleeding may require endoscopic management. Here, we present 2 cases of life-threatening upper GI bleeding secondary to MWT. Case 1 is a 55-year-old male with known Obesity Hypoventilation Syndrome who presented with a violent cough and was initially admitted with respiratory distress. He became hypoxic and hypercarbic while on the ward and was transferred to the Intensive care Unit (ICU). A copious amount of fresh blood was drained upon passage of a nasogastric tube. The second case is a 31-year-old male who abuses alcohol. He presented with five episodes of vomiting followed by 4 episodes of hematemesis. Initially, conservative management failed to stop the bleeding in both cases; hence, an upper Gastrointestinal (GI) endoscopy was done, which diagnosed a MWT in both cases. Haemostasis was achieved in both cases using monopolar coagulation forceps. The use of monopolar coagulation forceps is a safe and effective tool in combination with other endoscopic modalities in managing significant bleeding from MWT. Monopolar coagulation forceps are much easier to use over the bipolar heater probe.