Segmental jejunal “watermelon-like” vascular ectasia in portal hypertensive enteropathy: rationale for medical therapy over argon plasma coagulation

Introduction: Small bowel angiodysplasias account for over 50% of causes of small bowel bleeding and carry a worse prognosis than lesions located elsewhere in the gastrointestinal tract.Re-bleeding rates are high even after first-line endoscopic therapy and are associated with high levels of morbidity for affected patients.Small trials of long-acting somatostatin analogues have shown promising results but have not yet been assessed in patients with refractory small bowel disease.Aim: The purpose of this study was to assess the effect of long-acting somatostatin analogues in reducing re-bleeding rates and transfusion requirements, and improving haemoglobin levels in patients with refractory small bowel angiodysplasia.Methods: Patients with refractory small bowel angiodysplasia were treated with 20 mg of long-acting octreotide for a minimum of three months.Response was assessed according to: rates of re-bleeding, haemoglobin levels, transfusion requirements, and side effects.Results: A total of 24 patients were initially treated and 20 received at least three doses.Rates of complete, partial and nonresponse were 70%, 20% and 10% respectively.Average haemoglobin rates increased from 9.19 g/dl to 11.35 g/dl (p ¼ 0.0027, 95% confidence interval (CI) À3.5 to À1.1) in the group overall and 70% remained transfusion-free after a mean treatment duration of 8.8 months.The rate of adverse events was higher than previously reported at 30%.Conclusion: Long-acting somatostatin analogues offer a therapeutic advantage in a significant proportion of patients with small bowel angiodysplasia.With careful patient selection and close observation, a long-acting somatostatin analogue should be considered in all patients with persistent anaemia attributable to refractory disease in conjunction with other standard treatments.