When should I consider referring a patient with a Mallory-Weiss tear for endoscopy or surgical intervention?

For a patient with a Mallory-Weiss tear, which is a cause of upper gastrointestinal bleeding, the timing of endoscopy and consideration for surgical intervention depend on the patient's stability and response to initial treatment.

• Endoscopy:
  • Offer endoscopy immediately after resuscitation for patients who are unstable with severe acute upper gastrointestinal bleeding NICE CG141.
  • For all other patients with upper gastrointestinal bleeding, offer endoscopy within 24 hours of admission NICE CG141.
• Surgical Intervention or Repeat Endoscopy:
  • If a patient re-bleeds, offer a repeat endoscopy with a view to further endoscopic treatment or emergency surgery NICE CG141.
  • For unstable patients who re-bleed after endoscopic treatment, offer interventional radiology. If interventional radiology is not promptly available, refer urgently for surgery NICE CG141.
  • Consider a repeat endoscopy, with treatment as appropriate, for all patients at high risk of re-bleeding, particularly if there is doubt about adequate haemostasis at the first endoscopy NICE CG141.