Treatment of gastrointestinal angiodysplasia and unmet needs.
BACKGROUND
Gastrointestinal angiodysplasia (GIAD) may either be asymptomatic or induce overt or obscure bleeding with a high risk of recurrence. Numerous therapeutic options are available but evidence bases are lacking.


OBJECTIVE
We conducted a comprehensive review of pharmacological and endoscopic treatments for previous or active bleeding GIAD and established the unmet needs of the clinicians.


METHODS
Clinical trials, series, and reports, having been selected through PubMed inquiry, manual searching, and reference list reviewing, were classified by levels of evidence.


RESULTS
Controlled studies focusing on GIAD treatment, excluding other GI vascular malformations, are rare. Endoscopic destruction, preferably using non-contact endoscopic techniques, is most often proposed as a first-line treatment for GIAD (expert level). In addition, APC is preferred over Nd:Yag laser due to the lower risk of perforation (expert level). Pharmacological treatments for GIAD are considered either when endoscopy fails to access the AD or in order to prevent rebleeding for "chronic bleeding patients." Octreotide and oestroprogestative treatments are the best evaluated drugs; however, no appropriate comparison on cost-effectiveness and tolerance has been performed.


CONCLUSIONS
The most effective therapeutic strategy for bleeding GIAD is currently inconclusive, and new trials should be performed to address unmet needs.
AP-HP, Hôpital Lariboisière, Département Médico-chirurgical de Pathologie Digestive, Paris 7 University, France. xavier.dray@lrb.aphp.fr
Xavier
X
Dray
Marine
M
Camus
Jessica
J
Coelho
Violaine
V
Ozenne
Marc
M
Pocard
Philippe
P
Marteau
D016888:Angiodysplasia / Q000150:complications / Q000628:therapy*; D017679:Cryotherapy / Q000379:methods*; D004564:Electrocoagulation / Q000379:methods*; D004967:Estrogens / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008026:Ligation / Q000379:methods; D015282:Octreotide; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome
D004967:Estrogens; D005765:Gastrointestinal Agents; D015282:Octreotide