Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2016; 8(12): 792-795
Published online Dec 27, 2016. doi: 10.4240/wjgs.v8.i12.792
Bevacizumab and gastrointestinal bleeding in hereditary hemorrhagic telangiectasia
George Ou, Cherry Galorport, Robert Enns
George Ou, Cherry Galorport, Robert Enns, Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
Author contributions: Ou G, Galorport C and Enns R designed the report and drafted the article; Ou G and Galorport C collected the data; Ou G and Enns R drafted the manuscript; all authors contributed to the critical revision and final approval of the manuscript.
Institutional review board statement: Not applicable (Ethics approval not required for single case report as per University of British Columbia Research Ethics Board).
Informed consent statement: The patient provided written informed consent prior to participation in this case report.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Robert Enns, MD, FRCPC, Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Suite 770 - 1190 Hornby Street, Vancouver, BC V6Z 1Y6, Canada.
Telephone: +1-604-6886332-222 Fax: +1-604-6892004
Received: August 4, 2016
Peer-review started: August 5, 2016
First decision: August 26, 2016
Revised: September 7, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: December 27, 2016

We report a case of severe, refractory gastrointestinal (GI) bleeding in a patient with hereditary hemorrhagic telangiectasia (HHT) whose massive transfusion dependence was lifted shortly after treatment with bevacizumab, an anti-vascular endothelial growth factor. The patient’s bleeding had been refractory to repeated endoscopic interventions, tranexamic acid, and tamoxifen. However, following treatment with bevacizumab at 5 mg/kg every other week, nearly 300 units of packed red blood cell transfusions were avoided in one year’s time. Despite its relatively high cost, bevacizumab may have a more active role in the management of severe GI bleeding in HHT if such remarkable response can be consistently demonstrated.

Keywords: Bevacizumab, Vascular endothelial growth factor, Hereditary hemorrhagic telangiectasia, Bleeding, Osler-Weber-Rendu syndrome

Core tip: Management of gastrointestinal (GI) bleeding in patients with hereditary hemorrhagic telangiectasia (HHT) can be challenging when the vascular lesions recur despite repeated endoscopic treatments. There is increasing evidence supporting the use of anti-angiogenesis agents in the management of bleeding in HHT patients. Bevacizumab, a monoclonal antibody against vascular endothelial growth factor, has been shown to reduce recurrent epistaxis. This case demonstrates the therapeutic potential of bevacizumab in patients with severe GI bleeding requiring massive transfusions.