Treatment Options for Gastrointestinal Bleeding Blue Rubber Bleb Nevus Syndrome: a systematic review

Introduction: Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare challenging cause of gastrointestinal bleeding. We performed a systematic review of case reports and case series on BRBNS to gather information on the treatment options currently available. Method: All studies reporting a case of BRBNS in humans were evaluated. Papers were ruled out whether CARE criteria and explanations on patient's selection, ascertainment, causality, and reporting were not respected or identified. PROSPERO 2021 CRD 42021286982. Results: BRNBS was treated in 106 cases from 76 reports. 57.5% of the population was under 18 years old, and up to 50% of the cases reported a previous treatment. Clinical success was achieved in 98 patients (92.4%). Three main types of interventions were identified: systemic drug therapy, endoscopy and surgery. After BRBNS recurrence or previous therapy failure, systemic drug therapy emerged as a preferred second-line treatment over endoscopy (p=0.01), but with a higher rate of reported adverse events when compared with surgery and endoscopy (p < 0.001). Endoscopic treatment was associated with a higher number of required sessions to achieve complete eradication when compared with surgery (p < 0.001). No differences between the three main areas were found in the overall follow-up time (p=0.19) and in the recurrence rate (p=0.45). Conclusion: Endoscopy, surgery and systemic drug therapy are feasible treatment options for BRBNS. Systemic drug therapy was the favourite second-line treatment after endoscopic failure or recurrence of BRBNS, but adverse events were more frequently reported.