Higashino Makoto, Murakami Hidehiro, Hirata Tetsu, Miyaoka Hiroaki
Department of Internal Medicine Saiseikai Matsuyama Hospital Ehime Japan.
Department of Internal Medicine Ozu City Hospital Ehime Japan.
DEN Open. 2024 Nov 19;5(1):e70033. doi: 10.1002/deo2.70033. eCollection 2025 Apr.
Mallory-Weiss syndrome (MWS) is a common cause of gastroesophageal bleeding. Vomiting increases intra-abdominal and intra-esophageal pressures, causing hyperextension of the esophagogastric junction and laceration. Most affected patients respond well to conservative treatment; however, those with active bleeding require endoscopic intervention. Upon contacting blood, PuraStat gels and coats the bleeding point to achieve hemostasis. PuraStat is reportedly effective for non-variceal bleeding and bleeding associated with endoscopic procedures. However, there have been no reports on the use of PuraStat in MWS. Here we report a case in which PuraStat was useful for achieving hemostasis in a patient with MWS and difficult-to-achieve hemostasis. The patient was a 67-year-old man who had undergone coronary artery bypass grafting 1 month earlier and was taking an antithrombotic drug. He visited our hospital with bloody vomiting and melena in the evening and was diagnosed with upper gastrointestinal bleeding for which he underwent endoscopy. MWS with active bleeding was observed in the lower esophagus extending to the esophagogastric junction. We treated the patient with clipping; however, the oozing did not stop because of the large laceration. We applied PuraStat to the bleeding site and confirmed that the oozing had resolved; therefore, the procedure was terminated. The endoscope was reinserted the next day and confirmed the hemostasis. The patient was discharged without further deterioration. In patients with MWS with active bleeding, endoscopic hemostasis is commonly achieved using clips or endoscopic band ligation. However, PuraStat can achieve complete hemostasis when these techniques fail.
马洛里-魏斯综合征（MWS）是胃食管出血的常见原因。呕吐会增加腹内压和食管内压，导致食管胃交界处过度伸展并撕裂。大多数受影响的患者对保守治疗反应良好；然而，那些有活动性出血的患者需要内镜干预。接触血液后，PuraStat会凝胶化并覆盖出血点以实现止血。据报道，PuraStat对非静脉曲张性出血和与内镜手术相关的出血有效。然而，尚无关于在MWS中使用PuraStat的报道。在此，我们报告一例PuraStat对一名MWS且难以止血的患者实现止血有用的病例。该患者为一名67岁男性，1个月前接受了冠状动脉搭桥手术，正在服用抗血栓药物。他于晚上因呕血和黑便前来我院就诊，被诊断为上消化道出血并接受了内镜检查。在食管下段延伸至食管胃交界处观察到伴有活动性出血的MWS。我们用夹子对患者进行了治疗；然而，由于撕裂口较大，渗血不止。我们将PuraStat应用于出血部位，确认渗血已停止；因此，手术终止。第二天重新插入内镜并确认止血。患者出院时病情未进一步恶化。对于有活动性出血的MWS患者，内镜止血通常使用夹子或内镜套扎术来实现。然而，当这些技术失败时，PuraStat可以实现完全止血。
