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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(04): E368-E385
DOI: 10.1055/a-1984-6895
Original article

Topical hemostatic agents in the management of upper gastrointestinal bleeding: a meta-analysis

Ali A. Alali
1   Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
,
Sarvee Moosavi
2   Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
,
Myriam Martel
3   Research Institute of the McGill University Health Center, Montreal, Canada
,
Majid Almadi
4   Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
,
Alan N. Barkun
5   Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
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Abstract

Background and study aims Novel topical hemostatic agents have shown promising results in treating patients with non-variceal upper gastrointestinal bleeding (NVUGIB). However, data are limited even in published meta-analyses as to their role, especially compared to conventional endoscopic approaches. The aim of this study was to perform a highly comprehensive systematic review assessing the effectiveness of topical hemostatic agents in UGIB in different clinical settings.

Methods We performed a literature search of OVID MEDLINE, EMBASE, and ISI Web of Knowledge databases through September 2021. Studies assessing the efficacy of topical hemostatic agents in UGIB were included. Main outcomes were immediate hemostasis and overall rebleeding.

Results A total of 980 citations were identified and 59 studies with a total of 3,417 patients were included in the analysis. Immediate hemostasis was achieved in 93 % (91 %; 94 %), with similar results according to etiology (NVUGIB vs. variceal), topical agent used, or treatment strategy (primary vs. rescue). The overall rebleeding rate was 18 % (15%; 21 %) with the majority of rebleeds occurring in the first 7 days. Among comparative studies, topical agents achieved immediate hemostasis more often than standard endoscopic modalities (OR 3.94 [1.73; 8.96), with non-different overall rebleeding odds (OR 1.06 [0.65; 1.74]). Adverse events occurred in 2 % (1 %; 3 %). Study quality was overall low to very low.

Conclusions Topical hemostatic agents are effective and safe in the management of UGIB with favorable outcomes when compared to conventional endoscopic modalities across a variety of bleeding etiologies. This is especially true in novel subgroup analyses that assessed immediate hemostasis and rebleeding among RCTs and in malignant bleeding. Due to methodological limitations of available data, additional studies are needed to ascertain their effectiveness more confidently in the management of patients with UGIB.

Supplementary material



Publication History

Received: 21 June 2022

Accepted after revision: 17 November 2022

Accepted Manuscript online:
22 November 2022

Article published online:
24 April 2023

© 2022. 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/)

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