Background and Aims

Despite advances in endoscopic therapies, malignancy-related GI bleeding remains difficult to manage with high rates of treatment failure and rebleeding. Topical hemostatic agents (THAs) are easier to apply to the wide bleeding surface of tumors. We conducted this systematic review and meta-analysis to evaluate the efficacy of THAs in malignancy-related GI bleeding.

Methods

We conducted a comprehensive search of multiple electronic databases to identify studies reporting on the use of THAs in malignancy-related GI bleeding. The primary outcome was the achievement of hemostasis; secondary outcomes were early rebleeding (≤3 days), delayed rebleeding (>3 days), aggregate rebleeding, all-cause mortality, and GI bleeding–related mortality. A meta-analysis of proportions was done for all outcomes.

Results

Out of 355 citations, 16 studies with 530 patients were included. Primary hemostasis was achieved in 94.1% (95% confidence interval [CI], 91.5-96.0). Early rebleeding was seen in 13.9% (95% CI, 9.7-19.4) and delayed rebleeding in 11.4% (95% CI, 5.8-21.1). Aggregate rebleeding was seen in 24.2% (95% CI, 18.5-31.0). All-cause mortality was 33.1% (95% CI, 23.7-44.0), whereas GI bleeding–related mortality occurred in 5.9% (95% CI, 2.2%-14.8).

Conclusions

THAs are highly effective for achieving primary hemostasis in malignancy-related GI bleeding. It should be considered as an alternative to traditional endotherapy methods in malignancy-related GI bleeding. Future studies should be designed to evaluate its efficacy and safety as a primary method of hemostasis as compared with traditional endotherapy measures.

中文翻译：

---

局部止血剂治疗恶性肿瘤相关胃肠道出血的疗效：系统评价和荟萃分析

 背景和目标

尽管内窥镜治疗取得了进展，但与恶性肿瘤相关的胃肠道出血仍然难以治疗，治疗失败和再出血的比率很高。局部止血剂（THA）更容易应用于肿瘤的广泛出血表面。我们进行了这项系统评价和荟萃分析，以评估 THAs 在与恶性肿瘤相关的胃肠道出血中的疗效。

 方法

我们对多个电子数据库进行了全面检索，以确定有关使用 THA 治疗恶性肿瘤相关胃肠道出血的研究报告。主要结局是实现止血；次要结局是早期再出血（≤3天）、延迟再出血（>3天）、总再出血、全因死亡率和胃肠道出血相关死亡率。对所有结果进行了比例荟萃分析。

 结果

在 355 篇引用中，纳入了 16 项涉及 530 名患者的研究。初次止血率为 94.1%（95% 置信区间 [CI]，91.5-96.0）。 13.9%（95% CI，9.7-19.4）出现早期再出血，11.4%（95% CI，5.8-21.1）出现延迟再出血。 24.2% 的患者出现再次出血（95% CI，18.5-31.0）。全因死亡率为 33.1%（95% CI，23.7-44.0），而胃肠道出血相关死亡率为 5.9%（95% CI，2.2%-14.8）。

 结论

THA 对于实现恶性肿瘤相关胃肠道出血的初步止血非常有效。它应被视为治疗恶性肿瘤相关胃肠道出血的传统内科治疗方法的替代方法。未来的研究应旨在评估其作为主要止血方法与传统内科治疗措施相比的有效性和安全性。