Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-1495-4764
Effectiveness of hemostatic powders in lower gastrointestinal bleeding: a systematic review and meta-analysis
![](https://www.thieme-connect.de/media/10.1055-s-00025476/202108/lookinside/thumbnails/2294_10-1055-a-1495-4764-1.jpg)
Abstract
Background and study aims There is limited evidence on the effectiveness of hemostatic powders in the management of lower gastrointestinal bleeding (LGIB). We aimed to provide a pooled estimate of their effectiveness and safety based on the current literature.
Patients and methods Literature review was based on computerized bibliographic search of the main databases through to December 2020. Immediate hemostasis, rebleeding rate, adverse events, and mortality were the outcomes of the analysis. Pooled effects were calculated using a random-effects model.
Results A total of 9 studies with 194 patients were included in the meta-analysis. Immediate hemostasis was achieved in 95 % of patients (95 % confidence interval [CI] 91.6 %–98.5 %), with no difference based on treatment strategy or bleeding etiology. Pooled 7- and 30-day rebleeding rates were 10.9 % (95 %CI 4.2 %–17.6 %) and 14.3 % (95 %CI 7.3 %–21.2 %), respectively. Need for embolization and surgery were 1.7 % (95 %CI 0 %–3.5 %) and 2.4 % (95 %CI 0.3 %–4.6 %), respectively. Overall, two patients (1.9 %, 95 %CI 0 %–3.8 %) experienced mild abdominal pain after powder application, and three bleeding-related deaths (2.3 %, 95 %CI 0.2 %–4.3 %) were registered in the included studies.
Conclusion Novel hemostatic powders represent a user-friendly and effective tool in the management of lower gastrointestinal bleeding.
Publication History
Received: 03 February 2021
Accepted: 14 April 2021
Article published online:
16 July 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Oakland K, Guy R, Uberoi R. et al. Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit. Gut 2018; 67: 654-662
- 2 Adegboyega T, Rivadeneira D. Lower GI bleeding: an update on incidences and causes. Clin Colon Rectal Surg 2020; 33: 28-34
- 3 Barkun AN, Moosavi S, Martel M. Topical hemostatic agents: a systematic review with particular emphasis on endoscopic application in GI bleeding. Gastrointest Endosc 2013; 77: 692-700
- 4 Giday SA, Kim Y, Krishnamurty DM. et al. Long-term randomized controlled trial of a novel nanopowder hemostatic agent (TC-325) for control of severe arterial upper gastrointestinal bleeding in a porcine model. Endoscopy 2011; 43: 296-269
- 5 Facciorusso A, Straus Takahashi M, Eyileten Postula C. et al. Efficacy of hemostatic powders in upper gastrointestinal bleeding: a systematic review and meta-analysis. Dig Liver Dis 2019; 51: 1633-1640
- 6 Gralnek IM, Dumonceau JM, Kuipers EJ. et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: a1-46
- 7 Wells GA, Shea B, O’Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013 http://www.ohri.ca/programs/clinical_epidemiology/oxford.html
- 8 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557
- 9 Chahal D, Lee JGH, Ali-Mohamad N. et al. High rate of re-bleeding after application of Hemospray for upper and lower gastrointestinal bleeds. Dig Liver Dis 2020; 52: 768-772
- 10 Chen YI, Barkun A, Nolan S. Hemostatic powder TC-325 in the management of upper and lower gastrointestinal bleeding: a two-year experience at a single institution. Endoscopy 2015; 47: 167-171
- 11 Hookey L, Barkun A, Sultanian R. et al. Successful hemostasis of active lower GI bleeding using a hemostatic powder as monotherapy, combination therapy, or rescue therapy. Gastrointest Endosc 2019; 89: 865-871
- 12 Holster IL, Brullet E, Kuipers EJ. et al. Hemospray treatment is effective for lower gastrointestinal bleeding. Endoscopy 2014; 46: 75-78
- 13 Ng JL, Marican M, Mathew R. Topical haemostatic powder as a novel endoscopic therapy for severe colonic diverticular bleeding. ANZ J Surg 2019; 89: E56-E60
- 14 Prei JC, Barmeyer C, Bürgel N. et al. EndoClot polysaccharide hemostatic system in nonvariceal gastrointestinal bleeding: results of a prospective multicenter observational pilot study. J Clin Gastroenterol 2016; 50: e95-e100
- 15 Rodríguez de Santiago E, Burgos-Santamaría D, Pérez-Carazo L. et al. Hemostatic spray powder TC-325 for GI bleeding in a nationwide study: survival and predictors of failure via competing risks analysis. Gastrointest Endosc 2019; 90: 581-590
- 16 Vitali F, Naegel A, Atreya R. et al. Comparison of Hemospray® and Endoclot™ for the treatment of gastrointestinal bleeding. World J Gastroenterol 2019; 25: 1592-1602
- 17 Hussein M, Alzoubaidi D, Weaver M. et al. Use of hemospray in the treatment of lower gastrointestinal bleeds: outcomes from the international multicentre hemospray registry. Gastrointest Endosc 2020; 91: AB277
- 18 Mourad FH, Leong RW. Role of hemostatic powders in the management of lower gastrointestinal bleeding: a review. J Gastroenterol Hepatol 2018; 33: 1445-1453
- 19 Chen YI, Barkun AN. Hemostatic powders in gastrointestinal bleeding: a systematic review. Gastrointest Endosc Clin N Am 2015; 25: 535-552
- 20 de Rezende DT, Brunaldi VO, Bernardo WM. et al. Use of hemostatic powder in treatment of upper gastrointestinal bleeding: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E1704-E1713
- 21 Hussein M, Alzoubaidi D, Lopez MF. et al. Hemostatic spray powder TC-325 in the primary endoscopic treatment of peptic ulcer-related bleeding: multicenter international registry. Endoscopy 2021; 53: 36-43