Bevacizumab for refractory gastrointestinal angiodysplasia: a case report and literature review

Currently, symptomatic gastrointestinal (GI) angiodysplasia is treated with argon plasma coagulation (APC) via endoscopic procedures, supplemented with octreotide or thalidomide treatment. However, suboptimal response and side effects are often seen. Bevacizumab, an angiogenesis inhibitor, may provide an alternative systemic therapy for patients with refractory GI angiodysplasia. A 75-year-old male patient with cirrhosis and portal hypertension due to metabolic dysfunction-associated steatotic liver disease presented with recurrent anemia and overt GI bleeding. Initial endoscopic findings showed a combination of portal hypertensive gastropathy and GI angiodysplasia. Anemia persisted despite repeated APC and octreotide. After transjugular intrahepatic portosystemic shunt, portal hypertensive gastropathy resolved; however, GI angiodysplasia remained and caused refractory symptomatic anemia and overt bleeding. Finally, we resorted to off-label bevacizumab in the absence of other viable treatment options. The patient initially responded to treatment but has needed top-up dosing, the effect of which remains to be evaluated. In conclusion, we describe our initial experience with off-label bevacizumab in the treatment of refractory GI angiodysplasia. Based on our experience and literature, bevacizumab may be a viable option for patients with refractory GI angiodysplasia, which should be further evaluated in future studies before it can be implemented in clinical practice.