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Somatostatin analogs effectively reduced GIAD-related bleeding
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Somatostatin analogs effectively reduced bleeding in patients with gastrointestinal angiodysplastic lesions in a new meta-analysis of clinic trial data.
Investigators also reported that more than one-third of patients with gastrointestinal angiodysplastic lesions (GIADs) experienced rebleeding after endoscopic therapy.
Twenty-two eligible studies examining the efficacy of endoscopic, pharmacologic, or surgical therapy for GIADs were culled from PubMed, SCOPUS, and Cochrane central register of controlled trials. The resulting analysis included 831 individuals with GIADs, 623 patients who received endoscopic therapy, 63 with hormonal therapy, 72 with octreotide, and 73 patients who underwent aortic valve replacement (AVR) surgery.
Based on two case-control studies, hormonal therapy did not effectively reduce bleeding (OR=1, 95% CI, 0.5-1.96). In an analysis of 14 studies covering patients with gastric, colonic, and small-bowel GIADs, endoscopic therapy was most effective as an initial therapy. The pooled recurrence bleeding rate, however, was 34% (95% CI, 27-42%) during a mean of 22 ± 13 months.
When investigators included only small-bowel GIADs (n=341), rebleeding events increased to 45% (95% CI, 37-52%).
The efficacy of somatostatin analogs was assessed in four studies, with a pooled OR for bleeding cessation of 14.5 (95% CI, 5.9-36).
The role of AVR was assessed from two studies examining 73 patients with Heyde’s syndrome, with a reported event rate for rebleeding of 0.19 (95% CI, 0.11-0.3) during a mean postoperative follow-up period of 4 years.
“Given the relatively high recurrence rates published in the available literature, it may be time to reanalyze the management of GIADs, particularly in the subset of patients with comorbid conditions who are most likely to demonstrate rebleeding post endoscopy therapy,” the researchers wrote.
Disclosure:The researchers report no relevant financial disclosures.
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