Hemostatic powder for gastrointestinal malignant tumor bleeding

Gastrointestinal (GI) tumor bleeding remains a major clinical challenge worldwide, particularly for endoscopists. GI malignant tumor bleeding is uniquely characterized by diffuse oozing and friable tissue, which is vulnerable to further injury. This poses inherent limitations to conventional endoscopic treatments, resulting in low immediate hemostasis rates and a high risk of rebleeding. Traditional salvage surgery or embolization is the rescue treatment; however, they carry a higher mortality risk in the absence of stabilization. Importantly, survival in these patients depends on definitive oncological therapy, and endoscopic hemostasis is an essential frontline approach as a critical bridge to subsequent tumor treatment. Over the past decade, hemostatic powder has evolved into a promising treatment for malignant GI bleeding, distinguished by its ability to provide broad mucosal coverage through non-contact application. To date, adequately powered randomized controlled trials and meta-analyses have demonstrated superior immediate hemostasis and lower rebleeding rates with only a hemostatic powder agent (TC-325) over conventional endoscopic therapy. Thus, the efficacy of other hemostatic powder agents needs to be explored. To date, no luminal or systemic adverse events have been reported in studies on malignant bleeding, reassuring the safety of hemostatic powder in this setting.