Copyright ©The Author(s) 2019.
World J Gastroenterol. Jun 7, 2019; 25(21): 2549-2564
Published online Jun 7, 2019. doi: 10.3748/wjg.v25.i21.2549
Table 1 Risk factors for gastrointestinal angiodysplasias
Risk factors for gastrointestinal angiodysplasias
1 Age > 60 yr
2 Chronic obstructive pulmonary disease
3 Aortic stenosis (Heyde´s disease)
4 Low-flow left ventricular assist devices
5 Von Willebrand disease
6 Venous thromboembolism
7 Ischemic heart disease
8 Liver cirrhosis
9 Drugs1: Anti-platelet
Table 2 Stratification of small bowel angiodysplasias based on endoscopic characteristics by video capsule endoscopy or device-assisted enteroscopy, clinical manifestations, bleeding causality and hemorrhagic recurrence probability (García-Compeán D et al)
TypeEndoscopic characteristicsBleeding causalityClinical manifestationsBleeding recurrence probability
Type 1Punctuated or patchy lesions with non-pulsatile active bleedingCertainOvert bleeding; high frequency of hemodynamic instabilityVery high, without hemostatic treatment
Type 2Non-actively bleeding lesion; stigmata of hemorrhage (ulcer, adherent clot, digested blood debris)HighFrequently overt bleeding; lower frequency of hemodynamic instability than Type 1 lesionsHighly likely
Type 3Bright red spots; typical imagesModerate or mildOvert or occult bleeding; low or null frequency of hemodynamic instability Iron deficiency anemiaModerate rate; frequently IDA is dependent on iron supplements or blood transfusion
Type 4Pale red spotsLow or nullGenerally occult bleeding Chronic IDA; extra digestive cause of bleeding should be ruled outWhen other sources of bleeding have been excluded, re-bleeding is low
Table 3 Prospective and controlled trials evaluating the efficacy of hormonal therapy, somatostatin analogues and thalidomide in patients with recurrent bleeding due to gastrointestinal angiodysplasias confirmed by endoscopy
Author (yr)DesignnTreatmentFollow–up (mo)Results
Hormonal therapy
Van Cutsem et al[98], 1990DB, Cr Ov, Rx vs P,10Oral Ethinyloestradiol and norethisterone for 6 mo6Significant reduction of transfusion requirement in Rx patients vs controls (P < 0.003). Non-significant side effects in treated patients
Barkin and Ross[99],1998Cohort25Oral Mestranol and norethynodrel or norethinidrone18 (1-52)None patients rebled during Rx. Side effects in 44% of patients
Junquera et al[100], 2001R, DB, Rx vs PRx = 33 P = 35Oral Norethisterone and ethinylstradiol for 1-2 yr12 (12-36)Bleeding recurrence: Rx = 39% vs P = 46%; P = NS
Somatostatin analogues
Nardone et al[106], 1999Cohort17SC Octreotide 100 µg/8 h for 6 mo12Rates of complete, partial and non-response were 59%, 23% and 18% respectively; non-significant side effects
Junquera et al[107], 2007Cohort, Rx vs PRx = 32 P = 38SC Octreotide 50 µg/12 h for 12-24 mo13 (12-36)Bleeding recurrence: Rx = 23% vs P = 48% (P = 0.04); major adverse effects: Rx = 3.1% vs P = 2.6%
Scaglione et al[111], 2007Cohort13IM Lanreotide 10 mg/mo for 12 mo33 (12-60)Rates of complete, partial and non-response were 70% and 23% respectively; non-significant side effects were observed
Molina et al[111], 2009Cohort11IM Lanreotide 20 mg/mo15 (5-48)Patients with serious comorbidities; treatment reduced transfusion requirements and bleeding related hospitalizations
Bon et al[113], 2012Cohort15IM Lanreotide 20 mg/mo for 12 mo14 (10-36)Rx significantly reduced bleeding recurrences, transfusion requirements and increased serum Hb levels; side effect were rare
Holleran et al[108], 2016Cohort24IM Lanreotide 20 mg/mo for 3 mo8 (3-17)Rates of complete, partial and non-response were 70%, 20% and 10% respectively; adverse events: 30%
Ge et al[121], 2011Cohorts Rx vs CR = 28 C: 27Oral thalidomide 100 mg/day for 4 mo; oral iron 400 mg/day for 4 mo39 (8-52)Rate of response; Rx = 71.4 vs 3.7%; non-significant side effects
Garrido et al[119], 2012Cohort12Oral 200 mg/day for 4 mo4Increase of serum Hb levels; severe side effects requiring Rx discontinuation in 17%