Efficacy of topical hemostatic agents in malignancy-related GI bleeding: a systematic review and meta-analysis

• Published in: Gastrointestinal endoscopy 2023-02, Vol.97 (2), p.202-208.e8
• Main Authors: Karna, Rahul, Deliwala, Smit, Ramgopal, Balasubramanian, Mohan, Babu P., Kassab, Lena, Becq, Aymeric, Dhawan, Manish, Adler, Douglas G.
• Format: Article
• Language: English
• Subjects: Gastrointestinal Hemorrhage - drug therapy; Gastrointestinal Hemorrhage - etiology; Hemostasis, Endoscopic - methods; Hemostatics - therapeutic use; Humans; Neoplasm Recurrence, Local - complications; Recurrence
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2022.07.033

Despite advances in endoscopic therapies, malignancy-related GI bleeding remains difficult to manage with high rates of treatment failure and rebleeding. Topical hemostatic agents (THAs) are easier to apply to the wide bleeding surface of tumors. We conducted this systematic review and meta-analysis to evaluate the efficacy of THAs in malignancy-related GI bleeding. We conducted a comprehensive search of multiple electronic databases to identify studies reporting on the use of THAs in malignancy-related GI bleeding. The primary outcome was the achievement of hemostasis; secondary outcomes were early rebleeding (≤3 days), delayed rebleeding (>3 days), aggregate rebleeding, all-cause mortality, and GI bleeding–related mortality. A meta-analysis of proportions was done for all outcomes. Out of 355 citations, 16 studies with 530 patients were included. Primary hemostasis was achieved in 94.1% (95% confidence interval [CI], 91.5-96.0). Early rebleeding was seen in 13.9% (95% CI, 9.7-19.4) and delayed rebleeding in 11.4% (95% CI, 5.8-21.1). Aggregate rebleeding was seen in 24.2% (95% CI, 18.5-31.0). All-cause mortality was 33.1% (95% CI, 23.7-44.0), whereas GI bleeding–related mortality occurred in 5.9% (95% CI, 2.2%-14.8). THAs are highly effective for achieving primary hemostasis in malignancy-related GI bleeding. It should be considered as an alternative to traditional endotherapy methods in malignancy-related GI bleeding. Future studies should be designed to evaluate its efficacy and safety as a primary method of hemostasis as compared with traditional endotherapy measures.