Liu Kai, Zhang Wei, Gao Li, Bai Jiawei, Dong Xin, Wang Yue, Chen Hui, Dong Jiaqiang, Fang Nian, Han Ying, Liu Zhiguo
Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China.
Department of Obstetrics and Gynecology, Ordos Central Hospital, Ordos School of Clinical Medicine, Inner Mongolia Medical University, Ordos, China.
Gastrointest Endosc. 2025 Mar;101(3):539-550.e14. doi: 10.1016/j.gie.2024.08.042. Epub 2024 Sep 13.
Hemostatic powder (HP) is a novel hemostasis modality for nonvariceal GI bleeding. This 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 recurrent bleeding rate. After the meta-analysis, a trial sequential analysis (TSA) was also conducted to decrease the risk of random errors and validate the result.
The meta-analysis included 8 studies, incorporating 653 patients in total. Given significant heterogeneity, all analyses were segregated into malignancy-related and nonmalignancy-related GI bleeding lesions. For the former, HP monotherapy significantly improved the initial hemostasis rate and 30-day recurrent bleeding rate compared with CET (relative risk [RR], 1.50; 95% confidence interval [CI], 1.28-1.75; P < .001; RR, .32; 95% CI, .12-.86; P = .02, respectively), and TSA supported the results. For nonmalignancy-related GI bleeding, HP monotherapy and CET have similar initial hemostasis and 30-day recurrent bleeding rates (RR, 1.08; 95% CI, .98-1.19; P = .11; RR, 1.15; 95% CI, .46-2.90; P = .76, respectively), but the TSA failed to confirm the results.
HP monotherapy surpassed CET in terms of the initial hemostasis rate and 30-day recurrent bleeding rate for patients with malignancy-related GI bleeding. However, their relative efficacy for nonmalignancy-related GI bleeding remains unresolved.
止血粉（HP）是一种用于非静脉曲张性胃肠道出血的新型止血方式。本荟萃分析旨在评估HP单一疗法与传统内镜治疗（CET）用于非静脉曲张性胃肠道出血的疗效。
从数据库建立至2023年10月16日，系统检索了PubMed、EMBASE和Cochrane图书馆数据库。主要结局指标为初始止血率和30天再出血率。荟萃分析后，还进行了试验序贯分析（TSA）以降低随机误差风险并验证结果。
荟萃分析纳入8项研究，共653例患者。鉴于显著的异质性，所有分析均分为恶性肿瘤相关和非恶性肿瘤相关的胃肠道出血病变。对于前者，与CET相比，HP单一疗法显著提高了初始止血率和30天再出血率（相对危险度[RR]，1.50；95%置信区间[CI]，1.28 - 1.75；P <.001；RR，.32；95% CI，.12 -.86；P = .02），TSA支持这些结果。对于非恶性肿瘤相关的胃肠道出血，HP单一疗法和CET的初始止血率和30天再出血率相似（RR，1.08；95% CI，.98 - 1.19；P = .11；RR，1.15；95% CI，.46 - 2.90；P = .76）但TSA未能证实这些结果。
对于恶性肿瘤相关的胃肠道出血患者，HP单一疗法在初始止血率和30天再出血率方面优于CET。然而，它们对非恶性肿瘤相关胃肠道出血的相对疗效仍未明确。
