Introduction Angiodysplasias account for up to 50% of causes of small bowel bleeding and due to their relative inaccessibility and the intermittent nature of their bleeding they present a particular therapeutic challenge. Endoscopic ablation with APC is the most efficacious at reducing re-bleeding rates, however; its effect is short-lived and not all small bowel lesions are amenable to treatment via DBE. It has been suggested by a recent small trial that long-acting Octreotide may be beneficial at reducing re-bleeding rates.
Methods Following ethical approval patients with significant recurrent anaemia (≥6 months with RCC transfusions) and definite small bowel angiodysplasia (P2), on capsule endoscopy were invited to participate in an open label, uncontrolled pilot study of monthly 20 mg long acting Octreotide. Patients who had lesions amenable to APC via DBE were treated prior to commencing Octreotide. Baseline demographics, medications, endoscopy and capsule findings and Hb level were recorded. Patients were assessed at regular intervals and evaluated for side effects and episodes of bleeding (defined as either overt bleeding or a Hb drop of >1 g/dL). Patients who received fewer than three doses were excluded from analysis.
Results A total of 22 patients, 50% (n = 11) female, mean age of 72 years (range 55–92) have been recruited to date, 16 (73%) with isolated small bowel angiodysplasias and 6 with small bowel and colonic lesions. Of these, 17 (77%) received at least 3 doses, 11 (65%) had DBE and APC prior to commencing Octreotide, and 11 (65%) were on anticoagulants (4 warfarin, 7 aspirin and 2 dual antiplatelet therapy with aspirin and clopidogrel). The mean duration of treatment was 8.1 months (range 3–15). There was a statistically significant difference in mean baseline and follow up Hb levels, 8.7 g/dL (5–11.1) and 11.2 g/dL (8–14.3) respectively, p < 0.001. Overall there were 8 re-bleeding episodes in 5 patients (29%). Prior APC treatment did not affect outcome (Table 1). Significant side effects occurred in 3 patients (13.6%), 1 allergic skin reaction, 1 thrombocytopenia and 1 choledocholithiasis.
Conclusion Our study has shown that long acting intramuscular Octreotide is effective at improving Hb levels in patients with refractory small bowel angiodysplasias. A longer follow up interval will be required to determine the beneficial effect of combination therapy. We have identified a relatively high rate of serious side effects, in contrast to previous reports, which need to be taken into consideration prior to commencing treatment.
Disclosure of Interest None Declared.