title: Medical and endoscopic therapies for angiodysplasia and gastric antral vascular ectasia: a systematic review.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota.
authors.forename: Eric
authors.initials: E
authors.lastname: Swanson
authors.affiliation: Department of Medicine, Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota; Section of Gastroenterology, Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota.
authors.forename: Amar
authors.initials: A
authors.lastname: Mahgoub
authors.affiliation: Minnesota Evidence based Practice Center, Center for Chronic Disease and Outcome Research, Minneapolis, Minnesota.
authors.forename: Roderick
authors.initials: R
authors.lastname: MacDonald
authors.affiliation: Department of Medicine, Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota; Section of Gastroenterology, Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota. Electronic address: shaukat@umn.edu.
authors.forename: Aasma
authors.initials: A
authors.lastname: Shaukat
mesh_terms: D016888:Angiodysplasia / Q000188:drug therapy* / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D020252:Gastric Antral Vascular Ectasia / Q000188:drug therapy* / Q000601:surgery*; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents
keywords: Angiodysplasia; Comparison Analysis; Gastric Antral Vascular Ectasia; Systematic Review