title: Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis.
abstract: OBJECTIVE
  Gastrointestinal angiodysplastic lesions (GIADs) are defined as pathologically dilated communications between veins and capillaries. The objective of this systematic review and meta-analysis was to determine the efficacy of available treatment modalities for GIADs.
  
  
  METHODS
  We identified eligible studies by searching through PubMed, SCOPUS, and Cochrane central register of controlled trials. We searched for clinical trials examining the efficacy of endoscopic, pharmacologic, or surgical therapy for GIADs. 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 two authors from 22 studies, including 831 individuals with GIADs. 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.
  
  
  RESULTS
  Hormonal therapy, based on two case-control studies, was not effective for bleeding cessation (odds ratio: 1.0, 95% CI: 0.5-1.96). On the basis of 14 studies including patients with gastric, colonic, and small-bowel GIADs, endoscopic therapy was effective as initial therapy, but the pooled recurrence bleeding rate was 36% (95% CI: 28-44%) over a mean (±s.d.) of 22±13 months. The event rate for re-bleeding increased to 45% (95% CI: 37-52%) when studies including only small-bowel GIADs were included (N=341). In four studies assessing the efficacy of somatostatin analogs, the pooled odds ratio was 14.5 (95% CI: 5.9-36) for bleeding cessation. In two studies assessing the role of aortic valve replacement (AVR) in 73 patients with Heyde's syndrome, the event rate for re-bleeding was 0.19 (95% CI: 0.11-0.30) over a mean follow-up period of 4 years postoperatively.
  
  
  CONCLUSIONS
  Over one-third of patients with GIADs experienced re-bleeding after endoscopic therapy. Somatostatin analogs and AVR for Heyde's syndrome appeared to be effective therapy for GIADs.
authors.affiliation: Division of Gastroenterology, Loma Linda VA Medical Center, Loma Linda, California, USA.
authors.forename: Christian S
authors.initials: CS
authors.lastname: Jackson
authors.affiliation: Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Gerson
mesh_terms: D016888:Angiodysplasia / Q000150:complications / Q000628:therapy*; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation; D016558:Hemostasis, Endoscopic; D006488:Hemostasis, Surgical / Q000379:methods*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D015233:Models, Statistical; D015282:Octreotide / Q000627:therapeutic use; D016017:Odds Ratio; D012008:Recurrence; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D006490:Hemostatics; D013004:Somatostatin; D015282:Octreotide