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News

Management of gastrointestinal angiodysplastic lesions

The latest issue of the American Journal of Gastroenterology reviews the management of gastrointestinal angiodysplastic lesions.

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Gastrointestinal angiodysplastic lesions are defined as pathologically dilated communications between veins and capillaries.

Dr Lauren Gerson and colleagues from California, USA performed a systematic review and meta-analysis to determine the efficacy of available treatment modalities for gastrointestinal angiodysplastic lesions.

The team identified eligible studies by searching through PubMed, SCOPUS, and Cochrane central register of controlled trials.

The research team searched for clinical trials examining the efficacy of endoscopic, pharmacologic, or surgical therapy for gastrointestinal angiodysplastic lesions.

Data were pooled using a random-effects model, and the effect of response to medical or surgical therapy was reported as odds ratios with 95% confidence intervals (CIs).

Data and quality indicators were extracted by 2 authors from 22 studies, including 831 individuals with gastrointestinal angiodysplastic lesions.

The pooled recurrence bleeding rate was 36% over a mean of 22 months
American Journal of Gastroenterology

The analysis included 623 patients treated with endoscopic therapy, 63 with hormonal therapy, 72 patients with octreotide, and 73 status post aortic valve replacement surgery.

The team observed that hormonal therapy, based on 2 case–control studies, was not effective for bleeding cessation.

On the basis of 14 studies including patients with gastric, colonic, and small-bowel gastrointestinal angiodysplastic lesions, endoscopic therapy was effective as initial therapy, but the pooled recurrence bleeding rate was 36% over a mean of 22 months.

The researchers found that the event rate for re-bleeding increased to 45% when studies including only small-bowel gastrointestinal angiodysplastic lesions were included.

The team observed that in 4 studies assessing the efficacy of somatostatin analogs, the pooled odds ratio was 15 for bleeding cessation.

In 2 studies assessing the role of aortic valve replacement in 73 patients with Heyde's syndrome, the event rate for re-bleeding was 0.19 over a mean follow-up period of 4 years postoperatively.

Dr Gerson's team comments, "Over one-third of patients with gastrointestinal angiodysplastic lesions experienced re-bleeding after endoscopic therapy."

"Somatostatin analogs and aortic valve replacement for Heyde's syndrome appeared to be effective therapy for gastrointestinal angiodysplastic lesions."

Am J Gastroenterol 2014; 109:474–483
07 April 2014

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