P5192 - Somatostatin Analogues in the Management of Gastrointestinal Angiodysplasia: An Updated Meta-Analysis

Osama Ijaz, MD¹, Zoha Shahzad, MD², Badr Ilmaguook, MD³, Ishrat Fatima, MBBS⁴, Muhammad Abdul Moiz, MBBS⁵, Muhammad Shehroz Haider, MBBS⁶, FNU Samrah, MBBS⁴, Mah Rukh, MBBS⁷, Malik Ahsan Safdar, MBBS⁵, Yasir Rashid, MBBS⁶, Asad Gul Rao, MBBS⁸
1SSM Health St. Mary's Hospital - St. Louis, Richmond Heights, MO; 2One Brooklyn Health-Brookdale University Hospital Medical Center, Brooklyn, NY; 3NYC Health + Hospitals/Woodhull, Brooklyn, NY; 4Fatima Jinnah Medical University, Lahore, Punjab, Pakistan; 5Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; 6Rai Medical College, Sargodha, Punjab, Pakistan; 7Faisalabad Medical University, Faisalabad, Punjab, Pakistan; 8Dow University of Health Sciences, Karachi, Sindh, Pakistan

Introduction: Gastrointestinal angiodysplasias (GIADs) are fragile vascular malformations and a frequent cause of gastrointestinal bleeding, especially in elderly patients with comorbidities. While endoscopic therapies such as argon plasma coagulation are commonly used, they carry a high risk of rebleeding. Somatostatin analogues offer a pharmacologic alternative by inhibiting angiogenesis and reducing splanchnic blood flow. This updated meta-analysis evaluates the efficacy of somatostatin analogues in reducing transfusion needs in patients with GIADs, incorporating new evidence since 2021.

Methods: This systematic review and meta-analysis was conducted in accordance with PRISMA and Cochrane guidelines. A comprehensive search of MEDLINE, Embase, Scopus, and Cochrane Library was performed through May 2024 to identify randomized controlled trials (RCTs) and cohort studies evaluating somatostatin analogues (octreotide or lanreotide) in patients with GIADs. The primary outcome was the mean reduction in the number of red blood cell (RBC) transfusions during somatostatin analogue therapy compared with baseline, expressed as the incidence rate ratio (IRR). Study quality was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using the GRADE approach. Meta-analysis was performed using Open Meta-Analyst software.

Results: Twelve studies (RCTs and cohort studies) encompassing 243 patients met the inclusion criteria. Treatment with somatostatin analogues resulted in a significant reduction in RBC transfusion requirements, with a pooled IRR of 0.883 (95% CI: 0.828–0.937). Moderate heterogeneity was observed (I. = 48.7%, p = 0.029). Included studies were of moderate to high quality, and the certainty of evidence was graded as moderate due to variability across studies.

Discussion: Somatostatin analogues significantly reduce transfusion dependence in patients with gastrointestinal angiodysplasia and may serve as an effective non-invasive therapeutic option, particularly for patients who are not candidates for endoscopic treatment. Further well-designed randomized trials are needed to confirm these findings and establish long-term outcomes.


Figure: Forest plot showing the effect of somatostatin analogue therapy on red blood cell transfusion requirements in patients with gastrointestinal angiodysplasia, expressed as incidence rate ratios (IRR).

Disclosures:
Osama Ijaz indicated no relevant financial relationships.
Zoha Shahzad indicated no relevant financial relationships.
Badr Ilmaguook indicated no relevant financial relationships.
Ishrat Fatima indicated no relevant financial relationships.
Muhammad Abdul Moiz indicated no relevant financial relationships.
Muhammad Shehroz Haider indicated no relevant financial relationships.
FNU Samrah indicated no relevant financial relationships.
Mah Rukh indicated no relevant financial relationships.
Malik Ahsan Safdar indicated no relevant financial relationships.
Yasir Rashid indicated no relevant financial relationships.
Asad Gul Rao indicated no relevant financial relationships.

Osama Ijaz, MD¹, Zoha Shahzad, MD², Badr Ilmaguook, MD³, Ishrat Fatima, MBBS⁴, Muhammad Abdul Moiz, MBBS⁵, Muhammad Shehroz Haider, MBBS⁶, FNU Samrah, MBBS⁴, Mah Rukh, MBBS⁷, Malik Ahsan Safdar, MBBS⁵, Yasir Rashid, MBBS⁶, Asad Gul Rao, MBBS⁸. P5192 - Somatostatin Analogues in the Management of Gastrointestinal Angiodysplasia: An Updated Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.