Endoscopic therapy may be more effective in long-term control of upper gastrointestinal angioectasias when compared with somatostatin analogues

Background and study aims: Bleeding secondary to upper gastrointestinal angioectasias requires medical intervention, hospitalization, and transfusions. Endoscopic and medical therapies have been used to treat upper gastrointestinal angioectasias. Therapeutic efficacy of treatment modalities used in management of upper gastrointestinal angioectasias, specifically short- and long-term outcomes, remains an area of interest. Patients and methods: This was a retrospective cohort study utilizing TriNetX. ICD codes were used to identify patients with angioectasias of the upper gastrointestinal tract with concomitant iron deficiency anemia, while excluding patients with other vascular lesions of the upper gastrointestinal tract. Patients were subsequently divided into two groups, endoscopic and medical therapy group. Results: At 6 months, patients receiving endoscopic therapy demonstrated lower rates of hospitalization (70% vs 88%, P < 0.001), need for esophagogastroduodenoscopy (EGD) (30% vs 48%, P <0.001), and all-cause mortality (12% vs 22%, P = 0.002). At 3 years, endoscopic therapy was still superior in terms of EGD burden (42% vs 56%, P = 0.001), hospitalization (83% vs 91%, P = 0.008), all-cause mortality (26% vs 38%, P = 0.003), and blood transfusion (35% vs 45%, P = 0.013). At the 5-year interval, endoscopic therapy continued to demonstrate a reduced need for EGDs, hospitalizations, blood transfusions, and all-cause mortality. Mean hemoglobin was higher in the endoscopic cohort compared to the medical therapy at all intervals. Conclusions: Endoscopic therapy alone may provide better short and long-term clinical outcomes for patients with upper gastrointestinal angioectasias as compared with medical therapy with somatostatin analogues alone. Multicenter randomized clinical trials will need to be performed to further validate these findings.