S1413 Somatostatin Analogues in the Management of Gastrointestinal Angiodysplasia: An Updated Meta-Analysis

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. Conclusion: 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.