Approach to the management of an adult patient with a Mallory-Weiss tear on upper endoscopy

IV: intravenous; PPI: proton pump inhibitor.

* Patients with clinically significant upper gastrointestinal bleeding (ie, signs of active upper gastrointestinal bleeding including hematemesis, melena, or hematochezia, with or without hemodynamic instability or blood transfusion requirement) should be started on a high-dose twice-daily IV PPI prior to endoscopy as part of their initial management. The twice-daily IV PPI may be switched to oral PPI following endoscopy. Refer to UpToDate topics on management of upper gastrointestinal bleeding.

¶ The choice of treatment often depends on the preference of the endoscopist. Options include thermal coagulation with or without epinephrine local injection, endoscopic clips, endoscopic band ligation, and argon plasma coagulation. Hemostatic spray may be used in patients when these endoscopic treatments fail to control massive gastrointestinal bleeding.