AP-HP, Hôpital Lariboisière, Département Médico-chirurgical de Pathologie Digestive, Paris 7 University, France.
Dig Liver Dis. 2011 Jul;43(7):515-22. doi: 10.1016/j.dld.2010.12.007. Epub 2011 Jan 15.
Gastrointestinal angiodysplasia (GIAD) may either be asymptomatic or induce overt or obscure bleeding with a high risk of recurrence. Numerous therapeutic options are available but evidence bases are lacking.
We conducted a comprehensive review of pharmacological and endoscopic treatments for previous or active bleeding GIAD and established the unmet needs of the clinicians.
Clinical trials, series, and reports, having been selected through PubMed inquiry, manual searching, and reference list reviewing, were classified by levels of evidence.
Controlled studies focusing on GIAD treatment, excluding other GI vascular malformations, are rare. Endoscopic destruction, preferably using non-contact endoscopic techniques, is most often proposed as a first-line treatment for GIAD (expert level). In addition, APC is preferred over Nd:Yag laser due to the lower risk of perforation (expert level). Pharmacological treatments for GIAD are considered either when endoscopy fails to access the AD or in order to prevent rebleeding for "chronic bleeding patients." Octreotide and oestroprogestative treatments are the best evaluated drugs; however, no appropriate comparison on cost-effectiveness and tolerance has been performed.
The most effective therapeutic strategy for bleeding GIAD is currently inconclusive, and new trials should be performed to address unmet needs.
胃肠道血管发育不良（GIAD）可能无症状，也可能导致显性或隐匿性出血，且复发风险较高。有许多治疗选择，但缺乏证据基础。
我们对既往或活动性出血的 GIAD 的药物和内镜治疗进行了全面综述，确定了临床医生的未满足需求。
通过 PubMed 查询、手动搜索和参考文献回顾选择临床试验、系列研究和报告，并按证据水平进行分类。
针对 GIAD 治疗（不包括其他胃肠道血管畸形）的对照研究很少。内镜破坏，最好使用非接触式内镜技术，通常被提议作为 GIAD 的一线治疗（专家水平）。此外，由于穿孔风险较低，APC 优于 Nd:Yag 激光（专家水平）。当内镜无法到达 AD 或为了预防“慢性出血患者”再出血时，才会考虑 GIAD 的药物治疗。奥曲肽和雌孕激素治疗是评价最好的药物；然而，尚未对成本效益和耐受性进行适当比较。
目前对于出血性 GIAD 最有效的治疗策略尚无定论，应开展新的试验以满足未满足的需求。
