Somatostatin analogs in the treatment of gastrointestinal angiodysplasia bleeding: a systematic review.

Abstract

Aim: We aimed to perform a systematic review to gather evidence on the efficacy of somatostatin analogs (SA) in managing bleeding gastrointestinal angiodysplasias (GIADs).

Background: Some usual treatment modalities for bleeding caused by GIADs include endoscopic or surgical management. However, considering their availability and side effects, they may not be feasible for every patient. On that account, pharmacological management may become a safe and effective option.

Methods: In January 2024, a systematic review of the literature was conducted using the PubMed/Medline, Cochrane Library, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework was followed. Inclusion in this review was restricted to randomized clinical trials (RCTs) or observational studies comparing the use of SA as the main or complementary therapy in patients with GIADs. The outcomes of interest were hemoglobin levels, transfusion requirements, bleeding, and safety/adverse effects.

Results: Seven studies were included in the systematic review, two RCTs and five observational studies. There were 682 patients, of which 166 (24.3%) received any form of treatment involving SA. The studies varied greatly regarding follow-up, SA of choice, and other treatments associated with SA or as a control. Lanreotide appears to be able to significantly improve hemoglobin levels when associated with various treatments, whereas octreotide does not. One RCT found a significant reduction in blood or iron transfusion units when comparing SA to a standard of care, but other studies had mixed results. Lanreotide may be useful in reducing bleeding episodes in patients treated with argon plasma coagulation with double-balloon enteroscopy. Gastrointestinal adverse events such as diarrhea, vomiting, and abdominal pain were commonly reported across studies.

Conclusion: The majority but not all included studies suggest that SA may improve hemoglobin levels and reduce bleeding in patients with GIAD. However, the studies included small sample sizes and were not of strong statistical power. Further RCTs with larger populations are necessary to validate the effectiveness of SA in managing patients with GIAD.