Few studies have compared the efficacy and complications of endoscopic or medical therapies for bleeding angiodysplasias or gastric antral vascular ectasias (GAVE).
Dr Aasma Shaukat and colleagues from Minnesota, USA conducted a systematic review to evaluate therapies.
The researchers performed a PubMed search for studies 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.
|Thalidomide reduced the number of bleeding episodes|
|Clinical Gastroenterology & Hepatology|
The research team analyzed data from 63 studies that met inclusion criteria, of which 50 evaluated endoscopic treatment, 13 evaluated medical treatment, and 12 were comparative studies.
In patients with angiodysplasias, the combination of estrogen and progesterone did not significantly reduce bleeding episodes, compared with placebo, and increased mortality, compared with conservative therapy.
The team found that a higher percentage of patients receiving octreotide were free of rebleeding at 1 and 2 years vs placebo.
Thalidomide reduced the number of bleeding episodes, compared with iron therapy, but neither treatment reduced mortality.
The researchers noted that more patients with GAVE treated by endoscopic band ligation were free from rebleeding than those treated with argon plasma coagulation.
Dr Shaukat's team concludes, "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."