Original articleSystematic reviews and meta-analysesMedical and Endoscopic Therapies for Angiodysplasia and Gastric Antral Vascular Ectasia: A Systematic Review
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
References (86)
- et al.
Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia
Am J Gastroenterol
(2000) - et al.
Factors that contribute to blood loss in patients with colonic angiodysplasia from a population-based study
Clin Gastroenterol Hepatol
(2011) Etiology and prevalence of severe persistent upper gastrointestinal bleeding
Gastroenterology
(1983)- et al.
Chronic gastrointestinal bleeding of obscure origin: role of small bowel enteroscopy
Gastroenterology
(1988) - et al.
Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis
Gastroenterology
(2000) - et al.
Systematic reviews and meta-analyses in Clinical Gastroenterology and Hepatology
Clin Gastroenterol Hepatol
(2012) - et al.
Allocation concealment in randomised trials: defending against deciphering
Lancet
(2002) - et al.
A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia
Gastroenterology
(2001) - et al.
Medical therapy for chronic gastrointestinal bleeding of obscure origin
Am J Gastroenterol
(1998) - et al.
Push enteroscopic cauterization: long-term follow-up of 83 patients with bleeding small intestinal angiodysplasia
Gastrointest Endosc
(1996)
Usefulness of endoscopic band ligation for bleeding small bowel vascular lesions
Gastrointest Endosc
Endoscopic detachable mini-loop ligation for treatment of gastroduodenal angiodysplasia: case study of 11 patients with long-term follow-up
Gastrointest Endosc
Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias
Gastrointest Endosc
Mucosal vascular malformations of the gastrointestinal tract: clinical observations and results of endoscopic neodymium: yttrium-aluminum-garnet laser therapy
Mayo Clin Proc
Angiodysplasia of the colon: experience of 26 cases
Lancet
Treatment of chronic bleeding from gastric antral vascular ectasia (GAVE) with estrogen-progesterone in cirrhotic patients: an open pilot study
Am J Gastroenterol
Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation
Gastrointest Endosc
The beneficial effects of argon plasma coagulation in the management of different types of gastric vascular ectasia lesions in patients admitted for GI hemorrhage
Gastrointest Endosc
Bleeding gastric vascular ectasia treated by argon plasma coagulation: a comparison between patients with and without cirrhosis
Gastrointest Endosc
Long-term effect of argon plasma coagulation (APC) in the treatment of gastric antral vascular ectasia (GAVE)
Arab J Gastroenterol
Endoscopic argon plasma coagulation for the treatment of gastric antral vascular ectasia (watermelon stomach): long-term results
Dig Liver Dis
Development of hyperplastic polyps following laser therapy for watermelon stomach
Gastrointest Endosc
The watermelon stomach: long-term outcome in patients treated with Nd:YAG laser therapy
Gastrointest Endosc
Heat probe treatment for antral vascular ectasia
Gastrointest Endosc
Endoscopic cryotherapy for the treatment of bleeding mucosal vascular lesions of the GI tract: a pilot study
Gastrointest Endosc
Endoscopic cryotherapy for the management of gastric antral vascular ectasia
Gastrointest Endosc
Treatment of bleeding gastrointestinal vascular malformations with oestrogen-progesterone
Lancet
Inhibition of angiogenesis by somatostatin and somatostatin-like compounds is structurally dependent
J Surg Res
Management of gastropathy and gastric vascular ectasia in portal hypertension
Clin Liver Dis
The management of portal hypertensive gastropathy and gastric antral vascular ectasia
Dig Liver Dis
Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people
Am J Gastroenterol
Colonoscopic evaluation of rectal bleeding: a study of 304 patients
Ann Intern Med
Small bowel tumours: yield of enteroscopy
Gut
Diagnostic efficacy of push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias
Dig Dis Sci
The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding
Endoscopy
Gastroduodenal vascular ectasia in patients with liver cirrhosis
Dig Endosc
Endoscopic treatment outcomes in watermelon stomach patients with and without portal hypertension
Endoscopy
Angiodysplasia of the colon: a review of 17 cases
Arch Surg
Angiodysplasia of the lower gastrointestinal tract: an entity readily diagnosed by colonoscopy and primarily managed nonoperatively
Dis Colon Rectum
Gastric antral vascular ectasia in cirrhotic patients: absence of relation with portal hypertension
Gut
Diffuse gastric antral vascular ectasia: the “watermelon stomach” revisited
Am J Gastroenterol
Grading quality of evidence and strength of recommendations
BMJ
Does hormonal therapy have any benefit for bleeding angiodysplasia?
J Clin Gastroenterol
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2022, Annals of Medicine and SurgeryPrevalence of metabolic syndrome in cirrhotics with gastric antral vascular ectasia
2022, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :Many believe GAVE may occur through a similar pathway. In fact, there are several cases that treat refractory GAVE with thalidomide, a potent anti-VEGF agent [25–27]. Octreotide is known to suppress angiogenesis factors in addition to gastrin and has also been shown to have some success in GAVE treatment [27–29].
Endoscopic Treatment of Portal Hypertension and Its Complications
2022, Techniques and Innovations in Gastrointestinal EndoscopyNonvariceal Upper Gastrointestinal Bleeding
2019, Clinical Gastrointestinal EndoscopyPatient Presentation, Risk Stratification, and Initial Management in Acute Lower Gastrointestinal Bleeding
2018, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :Recurrent bleeding after a single episode of LGIB varies depending on the cause; in a single-center study 47% of patients with proven diverticular bleeding had recurrent bleeding after a median time of 8.1 months.38 Although for angioectasias, a small RCT estimated that the rate of recurrent bleeding in the placebo arm at 1 year was 45% and reached 64% at 2 years.39 Contrary to upper gastrointestinal bleeding, no study has assessed the acute discontinuation followed by early versus later reintroduction of ASA in LGIB (the former approach was favored in upper gastrointestinal bleeding based on one RCT40).
Prevention of Recurrent Lower Gastrointestinal Hemorrhage
2018, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :The management of angioectasia poses difficulty because several of these vascular malformations may be present concurrently10 and may subsequently develop in new locations.2 Overall, high-quality data are lacking to support routine use of medical therapy, including thalidomide, hormonal therapy, and octreotide, in the setting of angioectasia,11 particularly given the increased incidence of adverse events.2 In particularly difficult endoscopic situations, however, such as high angioectasia burden or inability to achieve hemostasis due to angioectasia location within the GI tract, medical therapy with the aforementioned agents may be considered.11,14
Conflicts of interest The authors disclose no conflicts.
Funding Supported by VA Career Development Award (CDA-2) (A.S.).