Octreotide for recurrent intestinal variceal bleeding in patients without portal hypertension

Abstract

We report on the efficacy of octreotide acetate in two patients with intestinal phlebectasia and no evidence of portal hypertension or mesenteric thrombosis. Patient 1 was a 46-year-old woman with primary pulmonary arterial hypertension. She required repeated transfusions for recurrent episodes of gastrointestinal bleeding (GIB). Intraoperative enteroscopy revealed wide-spread small bowel phlebectasia and intestinal resection was not performed. Blue rubber-bleb syndrome, portal hypertension and mesenteric thrombosis were ruled out. Octreotide acetate long-acting release was started. A transient interruption in treatment was followed by severe overt GIB. This was effectively controlled with continuous infusion of octreotide acetate. After this episode, octreotide acetate long-acting release was resumed and no further episodes of GIB have been reported until the most recent follow up (total duration of 74 months). Patient 2 was a 51-year-old woman with a history of recurrent GIB requiring multiple blood transfusions since young adulthood with negative endoscopic investigations. An enteroscopy showed numerous submucosal serpiginous varices in the colon and the terminal ileum. All putative causes including portal hypertension or mesenteric thrombosis were ruled out. Monthly intramuscular injections of long-acting octreotide acetate were initiated, and no GIB occurred since then (27 months of follow up). Somatostatin analogues are known to reduce splanchnic blood flow, to increase vascular resistance, to enhance platelet aggregation; and are thus efficacious in preventing GIB secondary to various vascular lesions (portal hypertension, intestinal angiodysplasia and blue rubber-bleb syndrome). These case reports suggest that they are also effective in preventing GIB in intestinal phlebactasia without portal hypertension.

An obscure cause of gastrointestinal bleeding: Recurrent duodenal variceal hemorrhage treated with intramuscular octreotide in the absence of portal hypertension

“…9 Medical management of EVs is lacking; however, somatostatin analogue therapy has proved to have merit in preventing intestinal variceal bleeding. 10 This is a case of DV secondary to scar tissue that was still amenable to treatment with beta-blockade and octreotide. On further assessment, no pre-hepatic, posthepatic, or intrahepatic cause was identifiable that would constitute a diagnosis of noncirrhotic PH.…”

“…High postsurgical mortality rates have resulted in surgical procedures being superseded by endoscopic and radiological alternatives, which have demonstrated modest success 9 . Medical management of EVs is lacking; however, somatostatin analogue therapy has proved to have merit in preventing intestinal variceal bleeding 10 …”

“… 9 Medical management of EVs is lacking; however, somatostatin analogue therapy has proved to have merit in preventing intestinal variceal bleeding. 10 …”

Role of octreotide in small bowel bleeding

“…In a case report, two patients who were diagnosed with intestinal variceal bleeding received octreotide over a span of 74 mo and 27 mo, respectively. The treatment was effective in preventing recurrent episodes of GI bleeding[ 73 ]. Another study reported a case of an 81-year-old female who presented with hematochezia and was diagnosed with small bowel varices that were caused by compression of the superior mesenteric vein due to a large pancreatic neuroendocrine tumor[ 74 ].…”