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Lanreotide in the management of small bowel angioectasias: seven-year data from a tertiary centre
S Chetcuti Zammit1, D S Sanders1, R Sidhu1
1a Department of Gastroenterology , Royal Hallamshire Hospital , Sheffield, UK.
Insights
Lanreotide injections significantly improved outcomes for patients with small bowel angioectasias (SBAs) and obscure gastrointestinal bleeding. The treatment enhanced hemoglobin levels and reduced bleeding episodes and transfusion needs.
Area of Science:
- Gastroenterology
- Vascular Medicine
- Pharmacology
Background:
- Small bowel angioectasias (SBAs) cause debilitating hemorrhage, particularly in elderly patients with comorbidities.
- Current treatments for SBA-related bleeding can be challenging and invasive.
Purpose of the Study:
- To evaluate the efficacy of lanreotide as an adjunct to endotherapy for managing small bowel angioectasias (SBAs).
Main Methods:
- A retrospective study included 12 patients with SBAs diagnosed via capsule endoscopy (CE) who received lanreotide injections.
- Efficacy was assessed by changes in hemoglobin levels, transfusion requirements, and bleeding episodes.
Main Results:
- Lanreotide treatment led to a significant improvement in mean hemoglobin levels (p=0.012).
- Patients experienced a significant reduction in bleeding episodes (p=0.010) and packed red cell transfusions (p=0.006).
- The number of deep bidirectional enteroscopies (DBEs) required also decreased significantly (p=0.048).
Conclusions:
- Lanreotide serves as an effective adjuvant therapy for refractory obscure gastrointestinal bleeding due to SBAs.
- It improves hematological parameters, reduces transfusion needs, and decreases the frequency of bleeding events.
- Lanreotide demonstrates a favorable safety profile in this patient cohort.
Background And Aims:
Haemorrhage from small bowel angioectasias (SBAs) can be debilitating to patients who are very often elderly and have multiple comorbidities. Our aim was to assess the use of lanreotide in addition to endotherapy in patients with SBAs.
Method:
Patients with SBAs on capsule endoscopy (CE) who received lanreotide injections from January 2010 to till the present day at the Royal Hallamshire Hospital in Sheffield were included. Baseline demographics were recorded. Efficacy was evaluated in terms of improvement in mean haemoglobin, transfusion requirements and bleeding episodes.
Results:
Twelve patients (67% males, mean age 74 SD ± 15.5 years) were included. All patients had multiple comorbidities. Lanreotide was given at a dosage of 60 mg (42%), 90 mg (33%) or 120 mg (25%). It was given at a four-week interval in 75% of patients and at a six-week interval in 17% of patients. One patient (8%) received a single dose. The mean duration of treatment was 19 months SD ± 14.5. Only 17% of patients had their lanreotide stopped due to cholelithiasis. There was a significant improvement in mean haemoglobin: 86.8 versus 98.0 (131-166 g/L, p = .012). The mean number of bleeding episodes (4.18 versus 1.09, p = .010) and packed red cells (323 versus 152, p = .006) received improved. Patients required less DBEs ± APCs after starting lanreotide (19 versus 11 p = .048).
Conclusion:
Lanreotide is a useful adjuvant treatment to therapeutic enteroscopy in patients with refractory obscure gastrointestinal bleeding due to SBAs. It improves haemoglobin levels, reduces transfusion requirements, bleeding episodes and number of DBEs. Overall, it has a good safety profile.
