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Introduction Gastric antral vascular ectasia (GAVE) and small bowel angiodysplasia are vascular malformations of the gastrointestinal tract that predispose patients to recurrent bleeding and anaemia. Some patients develop disease refractory to endoscopic argon plasma coagulation and repeated transfusions. Angiogenesis inhibitors such as bevacizumab have been proposed as an alternative treatment for refractory disease, limiting risks of prolonged and poorly tolerated endoscopic procedures. While limited case-based literature suggests reduced transfusion and endoscopic requirements, data on durability of response and timing of treatment failure remain scarce.Methods Patients receiving off-label bevacizumab for transfusion-dependent small bowel angiodysplasia or GAVE were identified via Trust pharmacy funding records. Data was extracted from electronic health records for 6 months prior to treatment, the first 6 months following treatment initiation, and until first documented re-bleed. Collected variables included demographics, mean haemoglobin, hospital admission length, iron and red blood cell transfusion requirements, time to re-bleed, and number of diagnostic/therapeutic gastroscopies and enteroscopies.Results 9 patients were identified (7 angiodysplasia, 2 GAVE), with a mean age of 78.3 years. 6 patients completed a full cycle (8 doses), while 3 received a mean of 4 doses. Mean baseline haemoglobin in the 6 months prior to bevacizumab initiation was 81.7 g/L, increasing by 28.2% to 104.8 g/L in the 6 months post treatment initiation. Mean red blood cell and iron transfusion requirements decreased from 10.7 and 2.7 pre-treatment to 6.06 and 0.89 post-treatment, respectively. One patient developed acute myeloid leukaemia and one had end-stage renal failure, potentially confounding transfusion needs. Mean hospital admission days for upper gastrointestinal bleeding fell from 14.9 to 2.2 days post-treatment. All patients required endoscopy pre-treatment, with seven undergoing therapy; this reduced to three patients in the first 6 months post-treatment and two patients between 6–12 months. Mean time to re-bleed was 253 days overall, increasing to 310 days among those completing the full treatment course. One patient had a documented adverse effect (severe hypertension), resolving after treatment cessation.Conclusion Bevacizumab was associated with improved mean haemoglobin, reduced transfusion and endoscopic requirements, fewer hospital admissions, and prolonged time to re-bleeding in patients with refractory small bowel angiodysplasia or GAVE. Benefit appeared sustained, particularly in patients completing a full treatment course, reducing procedural risks and frequency of hospital encounters. The cost of £2219 per cycle supports bevacizumab as a safe and cost-effective therapeutic option that may reduce reliance on recurrent invasive procedures. Outcomes from this cohort are contributing to the evolution of treatment protocols and local guidelines.