P057 Lanreotide for the treatment of chronic gastrointestinal bleeding from angioectasias in patients with portal hypertension: a case series

Abstract

<h3>Background</h3> Gastrointestinal haemorrhage from angioectasia are a common feature of patients with portal hypertensive enteropathy. Patients with angioectasia continue to be a challenge to manage despite the advancement in endoscopy. Advanced liver disease, significant co-morbidities and older age are some of the reasons patients may be refractory to conventional treatment. Somatostatin analogs have been used to good effect in acute bleeds in patients with portal hypertension but little data exists for its use in chronic gastrointestinal bleeding. Our aim was to assess the use of Lanreotide in patients who presented with chronic gastrointestinal bleeding due to angioectasias. <h3>Method</h3> Patients who were diagnosed to have angioectasia (gastric or small bowel) with portal hypertension at endoscopy and who received lanreotide injections were included. Aeitology of underlying portal hypertension, previous history of bleeding and endotherapy, transfusion history and any side effects of lanreotide was recorded. <h3>Results</h3> A total of 12 patients (75% Males, mean age 68) were identified between 2007 and 2020. Lanreotide 60mg (milligrams) given monthly, subcutaneously in all patients. Causes for portal hypertension: portal vein thrombus- 3 (25%); alcohol related liver disease - 3 (25%); Non-alcoholic fatty liver disease- 3 (25%); Primary biliary cholangitis- 1(8%), Alpha one antitrypsin deficiency - 1(8%). One patient (8%) had both alcohol and non-alcoholic fatty liver related liver disease. 11 of the 12 patients (92%) had oesophageal varices. All of these patients also had portal hypertensive gastropathy and at least one angioectatic lesion identified. One patient (8%) had portal hypertensive gastropathy only. Nine patients (75%) had prior treatment with either variceal banding, glue injection, argon plasma coagulation or interventional radiology embolisation. Two patients were also treated with a trans-jugular intrahepatic portosystemic shunt. After treatment with lanreotide, the average total number of bleeding episodes per patient reduced from 6 to 0.8. There was also a significant reduction in the average episodes of blood transfusions: 6 to 1. There were 6 (50%) patients who had an episode of rebleeding (defined as drop in haemoglobin and haemodynamic instability) in the first 6 months of treatment but did not require any endoscopic therapy. Only 1 person reported any side effects with Lanreotide (diarrhoea) and stopped treatment. <h3>Conclusion</h3> Lanreotide is a useful adjuvant treatment to therapeutic endoscopy in patients with refractory portal hypertensive bleeding due to angioectasia. It reduces transfusion requirements, bleeding episodes and overall improves patient quality of life with a good safety profile.