Table 5

Therapeutic trials for gastrointestinal (GI) bleeding in hereditary haemorrhagic telangiectasia (HHT)

Study	Subjects	No with HHT	Mean (range) age (years)	Intervention	% with follow-up	Mean follow-up (months)	Post-treatment outcome	Frequency post-treatment outcome	Procedural complication	Frequency complication
Bown et al 1985,109 Case series	18, severe GI bleeding, transfusion dependent	8/18 (44%)	62 (42–74)	100% 2 APC 6 ND-YAG (mean 7 sessions)	100%	14	Reduced transfusions No further transfusions Recurrence requiring surgery	8/8 (100%) 3/8 (38%) 3/8 (38%)	Perforation	0%
Gostout et al 1988,111 Case series	93, severe GI bleeding, transfusion dependent	10/93 (11%)	63	100% ND-YAG (2–6 sessions)	100%	15	Reduced transfusions	9/10 (90%)	Perforation Delayed bleeding	3/93 (3%) 5/93 (5%)
Sargeant et al 1993,110 Case series	41, severe GI bleeding, transfusion dependent	9/41 (22%)	66 (55–81)	100% ND-YAG (repeated sessions)	100%	51	Reduced or stabilised number of transfusions Reduction in mean yearly transfusions pre–post	6/9 (67%) 8 (4–42) vs 4 (0–44)	Perforation Antral narrowing	1/41 (2%) 2/41 (4%)
Van Cutsem et al 1990,106 Placebo-controlled cross-over trial	10, severe GI bleeding from VMs, transfusion dependent	6/10 (60%)	65–89	100% ethinylestradiol+norethisterone versus placebo	100%	6	Reduced mean transfusions pre–post^* No further bleeding	p<0.002 5/6	Death (MI) Feminising Vaginal bleeding	1/10 (10%) 1/10 (10%) 2/10 (20%)
Longacre et al 2003,103 Case series	43, HHT-related GI bleeding	43/43 (100%)	57 (33–78)	23/43 (53%) Medical therapy 19 ethinylestradiol/norethindrone 2 danacrine 2 aminocaproic acid	100%	18	Mean haemoglobin pre–post	8.6 vs 9.9 p=0.0018	DVT	1/19 (5%)

↵* Mean for all 10 patients (HHT and non-HHT).
APC, argon plasma coagulation; DVT, deep vein thrombosis; MI, myocardial infarction; Nd-YAG, neodymium-doped yttrium aluminium garnet. laser.