Abstract
Utilization of Hemostatic Powder Spray versus Standard Endoscopic Treatment in the Management of Malignancy-Related Gastrointestinal Bleeding : A Meta-analysis
Laurence Laurel, MD; Ziggy Amores, MD; Roel Galang, MD
St. Luke’s Medical Center – Global City
Significance: Managing tumoral bleeding poses significant challenges due to mucosal invasion and the limitations of traditional endoscopic tools, such as clips and heat-probes. Hemostatic powder sprays offer an innovative solution by forming a mechanical barrier to achieve hemostasis. This meta-analysis evaluates the efficacy and safety of Hemostatic powder sprays compared to standard endoscopic treatments in malignancy-related gastrointestinal bleeding (MRGB).
Methodology: Studies were included if they were randomized controlled trials (RCTs) comparing Hemostatic powder sprays with standard endoscopic treatments in MRGB and excluded if they lacked malignancy-specific outcomes or were case reports. A comprehensive search using terms like “Hemostatic powder,” “Hemospray,” and “malignancy-related gastrointestinal bleeding” was conducted in PubMed, Scopus, and Web of Science. Articles were assessed for quality using the Cochrane Risk of Bias tool, and disagreements were resolved by consensus among reviewers. Statistical analyses, including pooled odds ratios (ORs) and heterogeneity (I² statistic), were conducted using RevMan software with a random-effects model.
Results: Three RCTs involving 162 patients met our inclusion criteria. Hemostatic sprays significantly reduced the rebleeding rates (OR 0.36, 95% CI 0.15-0.84, p=0.01) compared to standard endoscopic treatments. A non-significant trend favoring Hemostatic powders for all-cause mortality was observed (OR 0.40, 95% CI 0.19-0.83, p=0.09). Adverse events were rare and comparable between groups. Funnel plots and sensitivity analyses indicated no publication bias.
Conclusion: Hemostatic powder sprays significantly reduce rebleeding rates and exhibit comparable safety to conventional treatments, supporting their role as an alternate intervention for malignancy-related gastrointestinal bleeding as bridge to surgery or interventional radiologic treatment. Further RCTs are warranted to refine protocols and validate their long-term outcomes.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |