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USEFULNESS AND SAFETY OF OCTREOTIDE IN GASTROINTESTINAL BLEEDING FROM ANGIODYSPLASIAS IN THE ELDERLY: A SINGLE-CENTER 12-YEAR EXPERIENCE

Sofia Ponte 1, Sara Archer 1, Ana Teresa Ferreira 1, Luís Maia 1, Paulo Salgueiro 1, Isabel Pedroto 1

Affiliations

1 Centro Hospitalar Universitário de Santo António, Porto, Portugal

Summary

AI Generated

A retrospective study of 19 elderly patients with chronic gastrointestinal bleeding from angiodysplasias treated with long-acting octreotide for at least 6 months found statistically significant increases in hemoglobin values and reduced transfusion requirements.

Among 19 patients (mean age 74.2 years, Charlson Index 6.37) who completed at least 6 months of intramuscular long-acting octreotide therapy, hemoglobin values increased significantly at 6 months (p=0.000) and at 24 months in the 8 patients who continued treatment (p=0.012).
Only 3 patients (15.8%) required red blood cell transfusions during the first 6 months of therapy, and just one presented with overt gastrointestinal bleeding.
The primary outcome of normal hemoglobin (≥12g/dl) without transfusions at 6 months was achieved in 5 patients (21.7%).
Adverse events occurred in 2 patients and led to drug suspension in only 1 patient (dysrhythmia).
Authors acknowledge limitations including retrospective design, small sample size, and inability to isolate the individual effect of octreotide from concomitant treatments (iron supplementation in 13 patients, argon plasma coagulation in 3).

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Abstract

Introduction

Angiodysplasias (AD) are the most common source of gastrointestinal (GI) bleeding of obscure origin in the elderly. In this population, GI AD often leads to red blood cell (RBC) transfusion-dependent anemia, resulting in high rate of hospitalizations and overuse of healthcare resources. Argon plasma coagulation (APC) is the standard treatment option, but it is an invasive procedure, with possible serious complications in the presence of significant comorbidities, and frequently ineffective in preventing recurrence of GI bleeding. Octreotide has been studied in this context, but currently it is not a widely recommended drug.

Aims & Methods

Aim: To evaluate the usefulness and safety of long-acting release-octreotide (LAR-OCT) in the control of bleeding from GI AD in elderly.
Methods: Retrospective study of patients diagnosed with chronic GI bleeding due to AD and treated with intramuscular LAR-OCT between January 2010 and December 2022 in a tertiary hospital was performed. Demographic and clinical data were collected. Exclusion criteria: LAR-OCT suspension before completing 6 months of treatment. Primary outcome: the presence of a normal Hb value (≥ 12g/dl) in the absence of any blood transfusions at 6 months(m) of therapy. Secondary outcomes: increase in Hb value, reduction of transfusional requirements and adverse events. Statistical analysis was performed with SPSS vs 25.0 (significance level of 0.05).

Results

Nineteen out of 23 patients completed at least 6m of LAR-OCT therapy. The mean age at diagnosis of AD was 74.2 years (62 to 89 years); 63.2% were female. The mean value of Charlson Comorbidity Index was 6.37 (estimated 10-year survival around 2%). Before starting LAR-OCT, 13 patients (68.4%) were under endovenous iron supplementation and 7 patients (36.8%) had undergone APC; 31.6% required at least 4 RBC units in the last month.
Primary outcome was achieved in 5 (21.7%) patients. There was a statistically significant increase in the Hb values in the first 6m of therapy (p=0.000). Three patients (15.8%) required RBC transfusions in this period, but only one presented with overt GI bleeding.
Only 8 patients achieved 24m of therapy, showing a statistically significant increase from initial to 24-m Hb values (p=0.012).
Twelve (52.2%) patients were under antithrombotic agents; there was a statistically significant difference between initial Hb and 6-m Hb value in this subgroup (p=0.002); between initial and 24-m values, there was an increase in the Hb value but not statistically significant (p=0.068).
Concomitant iron supplementation was performed in 13 and APC in 3 patients.
Adverse events were registered in 2 patients, leading to drug suspension in only 1 (dysrhythmia).

Conclusion

In the setting of “difficult-to-treat” patients with GI bleeding due to AD, octreotide has been proposed as an alternative therapeutic strategy. In this cohort of older patients, with a relatively low estimated 10-year survival due to its comorbidities, LAR-OCT appears to be effective in increasing Hb values while reducing the need of RBC transfusions and, therefore, the number of hospital admissions. This is particularly important in elderly patients, having a potential impact on their quality of life and on the healthcare costs associated with recurrent GI bleeding. Limitations of this study are the retrospective design, the small number of enrolled patients and the inability of analyzing the individual effect of LAR-OCT. Further studies are needed.

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 03 Small intestinal (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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