Gastrointestinal bleeding from vascular malformations: Is octreotide effective to rescue difficult-to-treat patients?
Gastrointestinal vascular malformations are responsible for 2-8% of all cases of bleeding and 30-40% of all obscure hemorrhages, being the most frequent cause of occult bleeding in older people. The aim of this review was to provide an up-to-date report about the use of octreotide in bleeding from both hereditary and acquired vascular malformations of the gastrointestinal tract. A systematic literature search was performed, using the keywords "gastrointestinal vascular malformation", "octreotide", "angiodysplasia", "portal hypertensive gastropathy", "gastric antral vascular ectasia", and "hereditary vascular malformations". The first line therapy of acute/chronic bleeding from digestive vascular malformations is endoscopy, followed by angiographic embolization and surgical resection when this is unsuccessful. In the setting of difficult-to-treat patients, octreotide has been proposed as an alternative therapeutic strategy. Studies reported in the literature show a high efficacy and safety of octreotide, but described only a small number of enrolled patients, heterogeneous therapeutic schedules and short-term follow-up, with the exception of acute bleeding from esophageal varices. As a consequence, the use of octreotide is not approved in this setting and it is currently still prescribed as an off-label drug. Studies in larger populations are needed to confirm the promising results observed in the small case series reports, so as to provide physicians with a treatment option for patients without available alternatives. Octreotide could also determine a strong decrease in the management costs of these clinical conditions, and especially, could dramatically reduce hospital admission costs.
Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Andrea
A
Iannone
Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Mariabeatrice
M
Principi
Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Michele
M
Barone
Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Giuseppe
G
Losurdo
Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. Electronic address: ierardi.enzo@gmail.com.
Enzo
E
Ierardi
Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Alfredo
A
Di Leo
D003362:Cost-Benefit Analysis; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use*; D056687:Off-Label Use; D054079:Vascular Malformations / Q000150:complications*
D005765:Gastrointestinal Agents; D015282:Octreotide