Original article
Systematic reviews and meta-analyses
Medical and Endoscopic Therapies for Angiodysplasia and Gastric Antral Vascular Ectasia: A Systematic Review

https://doi.org/10.1016/j.cgh.2013.08.038Get rights and content

Background & Aims

Few studies have compared the efficacy and complications of endoscopic or medical therapies for bleeding angiodysplasias or gastric antral vascular ectasias (GAVE). We conducted a systematic review to evaluate therapies.

Methods

We performed a PubMed search for studies (written in English from January 1, 1980, through January 1, 2013) of medical or endoscopic treatment of bleeding angiodysplasias and GAVE. Measured outcomes included levels of hemoglobin, transfusion requirements, rebleeding rates, complications, treatment failures, and overall mortality.

Results

We analyzed data from 63 studies that met inclusion criteria; 50 evaluated endoscopic treatment (1790 patients), 13 evaluated medical treatment (392 patients), and 12 were comparative studies. In patients with angiodysplasias, the combination of estrogen and progesterone did not significantly reduce bleeding episodes, compared with placebo (0.7/y vs 0.9/y, respectively), and increased mortality, compared with conservative therapy (33% vs 21%). A higher percentage of patients receiving octreotide were free of rebleeding at 1 and 2 years vs placebo (77% vs 55% and 68% vs 36%, respectively; P = .03). Thalidomide reduced the number of bleeding episodes (–8.96/y), compared with iron therapy (–1.38/y, P < .01), but neither treatment reduced mortality. More patients with GAVE treated by endoscopic band ligation were free from rebleeding (92%) than those treated with argon plasma coagulation (32%, P = .01).

Conclusions

In a systematic review, we found a low quality of evidence to support treatment of angiodysplasias with thalidomide or the combination of estrogen and progesterone and insufficient evidence to support treatment with octreotide. There is also insufficient evidence for endoscopic therapy of angiodysplasia or GAVE. Well-designed randomized controlled trials are needed to study the efficacy and complications of medical and endoscopic treatments for patients with angiodysplasias or GAVE.

Section snippets

Data Collection and Selection

A PubMed search was performed on the Medline database for all studies in the English language published between January 1, 1980, and January 1, 2013, including the medical subject heading (MeSH) angiodysplasia/therapy (GAVE is categorized within the MeSH term angiodysplasia) and angiodysplasia or gastric antral vascular ectasia cross-referenced with thalidomide, octreotide, estrogen, progesterone, lenalidomide, atorvastatin, tranexamic acid, argon plasma coagulation, neodymium: yttrium aluminum

Results

A total of 429 citations resulted from the original search, of which only 49 studies fit inclusion criteria, with the largest percentage (35%) being excluded because of a sample size less than 5 patients. Fourteen additional studies that fit inclusion criteria were found by manually reviewing citations of other included articles. Of the 63 reviewed studies on GAVE and angiodysplasia, 50 were endoscopic (n = 1790) and 13 were medical (n = 392), with only 12 studies that used comparators included

Discussion

Overall, we found insufficient or low evidence regarding the efficacy for currently used modalities and agents. Most studies were small, retrospective, heterogeneous in population and setting, did not report the number or location where lesions were found, and had considerable variation in reporting outcomes across and within treatment modalities. Pooling results was not permissible, and determining generalized estimates of clinically relevant treatment effects was not feasible. Our findings

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    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by VA Career Development Award (CDA-2) (A.S.).

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