Hemostatic powder efficacy for the endoscopic management of malignant upper gastrointestinal bleeding

Upper gastrointestinal bleeding (UGIB) of neoplastic origin is a rare but life-threatening cause of bleeding. Endoscopic treatment is challenging due to diffuse oozing blood and high rates of rebleeding, despite coagulation and hemoclip use. Hemostatic powders can be an option in those patients. We aimed to determine the initial hemostatic rate and the rebleeding rate at 7 and 30 days, using hemostatic powders in patients with malignant UGIB at a national referral center in Mexico.

A retrospective, observational study was conducted on patients with malignant UGIB treated with hemostatic powder between 2018-2023. Demographic and clinical variables, endoscopic findings, and treatment results were analyzed. A central tendency analysis and the chi-square test were employed.

The study included 54 patients (54.7% were men), with a mean age of 54 years. A total of 40.7% were diagnosed with gastric cancer and presented with an episode of malignant UGIB. Of the endoscopic findings, 52% of patients had active malignant UGIB, most presenting with oozing bleeding (57.4%). EndoClot™ was the main monotherapy employed (81.5%), achieving initial homeostasis in 100% of cases. The rebleeding rate was 22.2% at 7 days and 44.4% at 30 days, with a 30-day accumulated mortality rate of 35.2%.

Malignant UGIB is a potentially life-threatening complication. Hemostatic powder use is highly recommendable due to its efficacy in the immediate control of bleeding. Nevertheless, its effect is temporary, suggesting its use as bridging therapy, facilitating bleeding stabilization and enabling the implementation of definitive hemostatic treatments.