Hemostatic Powder for Non-Malignant Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis of...

Area of Science:

• Gastroenterology
• Endoscopic interventions
• Gastrointestinal bleeding management

Background:

• Standard endoscopic treatment (SET) effectiveness for non-variceal upper gastrointestinal bleeding (NVUGIB) varies.
• Hemostatic powder (HP) shows promise for malignant lesions, but its efficacy in benign NVUGIB is unclear.

Purpose of the Study:

• To compare the effectiveness of HP versus SET as first-line therapy for non-malignant NVUGIB.
• To evaluate HP's efficacy in controlling bleeding from benign upper gastrointestinal lesions.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) sourced from PubMed, Embase, and Cochrane Library.
• Searched databases from inception to January 2025.
• Analyzed binary outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95% confidence intervals (CIs).

Main Results:

• Included 5 RCTs with 708 patients.
• HP showed a marginally lower risk of further bleeding during esophagogastroduodenoscopy (EGD) (RR 1.04; p=0.04).
• No significant differences in rebleeding rates, need for second treatment, or procedure time were observed. Subgroup analysis indicated HP's benefit was limited to Forrest IIa lesions, not active bleeding.

Conclusions:

• HP demonstrated a reduced risk of further bleeding during EGD for non-malignant NVUGIB with non-bleeding visible vessels.
• No significant difference in further bleeding during EGD for active bleeding or in rebleeding risk at various time points (1-30 days).