Effectiveness of hemostatic powder vs conventional endoscopic therapy for malignancy-related upper gastrointestinal bleeding: A multicenter retrospective cohort study

BACKGROUNDMalignancy-related upper gastrointestinal bleeding (UGIB) is often difficult to control endoscopically and is associated with frequent rebleeding.Hemostatic powder has recently emerged as a noncontact endoscopic modality that can achieve rapid hemostasis by covering large bleeding surfaces.However, evidence regarding its effectiveness in malignancy-related bleeding remains limited. AIMTo compare the clinical outcomes of hemostatic powder with those of conventional endoscopic therapy in patients with malignancy-related UGIB. METHODSWe conducted a multicenter retrospective cohort study including patients who underwent endoscopic treatment for malignancy-related UGIB between January 2017 and April 2023.Patients were divided into two groups: (1) A hemostatic powder group; and (2) A conventional therapy group.The primary outcome was immediate hemostasis.Secondary outcomes included early rebleeding (≤ 72 hours), delayed rebleeding (72 hours-30 days), transfusion requirement, length of hospital stay, and 30-day mortality.Propensity score matching was conducted to reduce confounding due to baseline differences. RESULTSA total of 213 patients were included (hemostatic powder group, n = 86; conventional therapy group, n = 127).Immediate hemostasis was achieved more frequently in the hemostatic powder group than in the conventional therapy group (97.7% vs 90.6%, risk difference of 7.1%, 95%CI: 1.1-13.1;P = 0.040).However, early rebleeding, delayed rebleeding, transfusion requirements, length of hospital stay, and 30-day mortality did not differ significantly between the groups.After 4 / 36 propensity score matching, immediate hemostasis remained higher in the hemostatic powder group (98.1% vs 84.9%, risk difference of 13.2%, 95%CI: 2.9-23.5;P = 0.031).Multivariable analysis identified prior cancer therapy, metastatic tumor origin, and a Rockall score ≥ 4 as independent predictors of 30-day rebleeding. CONCLUSIONHemostatic powder achieved a higher rate of immediate hemostasis than conventional therapy in malignancy-related UGIB without reducing rebleeding or 30-day mortality, suggesting a useful option for rapid initial hemostasis.