Introduction Small bowel vascular lesions are a common cause of obscure gastrointestinal (GI) bleeding, particularly in the elderly. Enteroscopy for argon plasma coagulation (APC) can be difficult and a proportion of patients continue to have recurrent bleeding despite endoscopic therapy. Pharmacological drugs are useful adjuvant treatment. The aim of this study was to assess the role of long acting somatostatin analogues (lanreotide) in patients with refractory GI bleeding.
Method We retrospectively evaluated the effect of lanreotide in patients with refractory GI bleeding. Baseline demographics, co-morbidities, medications and previous endoscopic therapy were recorded. Efficacy was evaluated in terms of improvement in mean haemoglobin, transfusion requirements and bleeding episodes (>2 g/dl drop in HB or overt bleeding).
Results Eleven patients (64% males, mean age 73 years) were treated with lanreotide between 2010–2014. All patients had multiple comorbidities including ischaemic heart disease (n = 10), diabetes (n = 6) and chronic kidney disease (n = 5). Three patients had a diagnosis of hereditary haemorrhagic telangiectasia. Six patients were on anticoagulants and 4 patients on aspirin whilst 4 patients were on transexamic acid. All patients had been requiring regular blood transfusions. The median duration of anaemia was 72 months. Lanreotide was given at a dosage of 60 mg (n = 5), 90mg (n = 3) or 120 mg (n = 3). Nine patients received a monthly dose; 1 patient received a 6 weekly dose and 1 patient received a single dose. The mean duration of treatment was 10.5 months (range 1–29 months). Eight out of 11 patients received endoscopic therapy with APC prior to commencing lanreotide. Four patients had further enteroscopy and APC during the treatment period with lanreotide. There was a significant difference in mean baseline and follow up haemoglobin levels with lanreotide therapy: 8.7 g/dl (7.3–10) vs. 9.7 g/dl (7.9 −11.8); p = 0.03. Transfusion requirements were reduced in all but 2 patients (p = 0.042). Bleeding episodes were reduced during the treatment period (0 episodes (n = 6), 2 episodes (n = 4), 4 episodes (n = 1) (p = 0.02). Fif death was aspiration pneumonia. In the endoscopically managed group, the 30 day mortality was 0%. One year mortality was 33% for the surgical group and 8% in the endoscopically managed group.
Conclusion Our data suggests that this procedure is safe and effective, particularly when compared to the surgical alternative in this high risk group. The success rate of this procedure was high, suggesting that by utilising this technique, surgery can be avoided in the majority of patients with buried bumper syndrome.
Disclosure of interest None Declared.
Binnebossal M, Klink CD, et al. Endoscopic Removal of Buried Bumper. Department of Surgery. RWTH Aachen University: Endoscopy. 2010:42:E17–18