Efficacy of hemostatic powders in upper gastrointestinal bleeding: A systematic review and meta-analysis

Abstract

BackgroundThere is limited evidence on the efficacy of hemostatic powders in the management of upper gastrointestinal bleeding. AimsProvide a pooled estimate of the efficacy and safety profile of hemostatic powders in digestive endoscopy. MethodsA computerized bibliographic search on the main databases was performed through December 2018. Pooled effects were calculated using a random-effects model. The primary outcome was immediate hemostasis rate. Secondary outcomes were rebleeding rate (either at 7 and 30 days), bleeding-related mortality, and all-cause mortality rate. ResultsA total of 24 studies, of which three were randomized-controlled trials, with 1063 patients were included in the meta-analysis. Immediate hemostasis was achieved in 95.3% (93.3%–97.3%) of patients, with no difference based on treatment strategy, hemostatic agent used, bleeding etiology. Success rate was slightly lower in spurting bleeding (91.9%). Hemostatic powders showed similar efficacy as compared to conventional endoscopic therapy (odds ratio: 0.84, 0.06–11.47; p = 0.9). Thirty-day rebleeding rate was 16.9% (9.8%–24%) with no difference in comparison to other endoscopic treatments (odds ratio 1.59, 0.35–7.21; p = 0.55). All-cause and bleeding-related mortality rates were 7.6% (4%–10.8%) and 1.4% (0.5%–2.4%), respectively. ConclusionNovel hemostatic powders represent a user-friendly and effective tool in the management of upper gastrointestinal bleeding.