Gastroenterology Unit, University of Foggia, Italy.
Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
Dig Liver Dis. 2019 Dec;51(12):1633-1640. doi: 10.1016/j.dld.2019.07.001. Epub 2019 Aug 7.
There is limited evidence on the efficacy of hemostatic powders in the management of upper gastrointestinal bleeding.
Provide a pooled estimate of the efficacy and safety profile of hemostatic powders in digestive endoscopy.
A 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.
A 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.
Novel hemostatic powders represent a user-friendly and effective tool in the management of upper gastrointestinal bleeding.
关于止血粉在治疗上消化道出血方面的疗效，目前仅有有限的证据。
提供止血粉在消化内镜治疗中的疗效和安全性概况的汇总评估。
通过 2018 年 12 月在主要数据库上进行计算机文献检索。使用随机效应模型计算汇总效果。主要结果是即刻止血率。次要结果为再出血率（7 天和 30 天）、与出血相关的死亡率和全因死亡率。
共有 24 项研究（其中 3 项为随机对照试验）纳入了 1063 例患者的荟萃分析。95.3%（93.3%-97.3%）的患者即刻止血，治疗策略、使用的止血剂、出血病因均无差异。喷射性出血的成功率略低（91.9%）。止血粉与传统内镜治疗相比具有相似的疗效（比值比：0.84，0.06-11.47；p=0.9）。与其他内镜治疗相比，30 天再出血率为 16.9%（9.8%-24%）（比值比 1.59，0.35-7.21；p=0.55）。全因死亡率和与出血相关的死亡率分别为 7.6%（4%-10.8%）和 1.4%（0.5%-2.4%）。
新型止血粉是一种方便易用且有效的上消化道出血治疗工具。
