Abstract
Hemostatic powder (HP) is a novel hemostasis modality for nonvariceal gastrointestinal (GI) bleeding. The meta-analysis was performed to evaluate the efficacy of HP monotherapy versus conventional endoscopic treatment (CET) for nonvariceal GI bleeding. PubMed, Embase, and Cochrane Library databases were systematically searched from inception to October 16, 2023. The primary outcomes were the initial hemostatic rate and the 30-day rebleeding rate. After the meta-analysis, the trial sequential analysis (TSA) was also conducted to decrease the risk of random errors and validate the result. The meta-analysis included eight studies, incorporating 653 patients in total. Given significant heterogeneity, all analyses were segregated into malignancy-related and non-malignancy-related GI bleeding lesions. For the former, HP monotherapy significantly improved the initial hemostasis rate and 30-day rebleeding rate compared to CET (Relative risk [RR] 1.50, 95% confidence interval [CI] 1.28 - 1.75, P < .001; RR .32, 95% CI .12 - .86, P = .02), and TSA supported the above results. For non-malignancy-related GI bleeding, HP monotherapy and CET have similar initial hemostasis and 30-day rebleeding rates (RR 1.08, 95% CI .98 - 1.19, P = .11; RR 1.15, 95% CI .46 - 2.90, P = .76), but the TSA failed to confirm the above results. In conclusion, HP monotherapy surpassed CET in terms of the initial hemostasis rate and 30-day rebleeding rate for patients with malignancy-related GI bleeding. However, their relative efficacy for non-malignancy-related GI bleeding remains unresolved.
Published Version
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