Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2025; 17(6): 107142
Published online Jun 16, 2025. doi: 10.4253/wjge.v17.i6.107142
Advancing hemostasis: A meta-analysis of novel vs conventional endoscopic therapies for non variceal upper gastrointestinal bleeding
Shivangini Duggal, Ishana Kalra, Keisha Kalra, Vicky Bhagat
Shivangini Duggal, Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
Ishana Kalra, Keisha Kalra, University of Michigan, University of Michigan, Michigan City, IN 48104, United States
Vicky Bhagat, Department of Gastroenterology, Atlantic Health System, Bayonne, NJ 07002, United States
Author contributions: Duggal S, Kalra I, Kalra K designed this paper; Duggal S, Kalra I, Kalra K investigation and review of relevant data and articles; Duggal S analysis data; Duggal S, Kalra I, Kalra K written the original draft; Bhagat V review and editing this paper. All authors discussed the findings described in the case and approved the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
PRISMA 2009 Checklist statement: The present systematic review and network meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA Network Meta-analyses Extension Statement. A literature search was conducted on Cochrane, MEDLINE, PubMed and Scopus libraries for all articles published up to October 2024. Only English language articles were included.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shivangini Duggal, MD, Internal Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Dr, El Paso, TX 79905, United States. sduggal@ttuhsc.edu
Received: March 17, 2025
Revised: April 7, 2025
Accepted: May 8, 2025
Published online: June 16, 2025
Processing time: 87 Days and 1.1 Hours
Abstract
BACKGROUND

Non variceal upper gastrointestinal bleeding (NVUGIB) is a life-threatening condition requiring prompt and effective hemostasis. Various endoscopic interventions, including novel hemostatic powders (HP), over-the-scope clips (OTSC), and traditional approaches, have been employed to manage upper gastrointestinal bleeding (UGIB). Despite advancements, comparative efficacy and safety of these modalities remain uncertain.

AIM

To evaluate the efficacy and safety of novel hemostatic interventions compared to conventional endoscopic techniques for managing UGIB.

METHODS

Cochrane, MEDLINE, PubMed and Scopus libraries were searched for randomized controlled trials (RCTs) published up to October 2024. Only RCTs comparing novel interventions, such as HP or OTSC, with conventional endoscopic treatments computed tomography (CT) were included. The primary outcome was the 30-day rebleeding rate. Secondary outcomes included initial hemostasis, short-term rebleeding rates, need for salvage therapy (surgical/angiographic), 30-day all-cause mortality, and bleeding-related mortality. We performed pairwise and network meta- analyses for all treatments.

RESULTS

Seventeen studies were included in this analysis. Regarding the 30-day rebleeding rate, OTSC and HP showed superior efficacy compared with CT [OTSC vs CT: Relative risk (RR): 0.47, 95% confidence interval (CI): 0.33-0.65; HP vs CT: RR: 0.73, 95%CI: 0.45-1.13], while OTSC and HP had comparable efficacy (RR: 0.56, 95%CI: 0.30-1.05). OTSC ranked the highest in the network ranking estimate for this outcome. For the secondary outcomes, OTSC demonstrated superior efficacy for the short-term rebleeding rate (OTSC vs CT: RR: 0.35, 95%CI: 0.14-0.74; HP vs CT: RR: 0.62, 95%CI: 0.28-1.35; OTSC vs HP: RR: 0.59, 95%CI: 0.17-1.67). Regarding the initial hemostasis rate, OTSC was slightly more effective than CT (OTSC vs CT: RR: 1.20, 95%CI: 1.06-1.57) and comparable to HP (OTSC vs HP: RR: 1.08, 95%CI: 0.89-1.40). There were no significant differences among treatments for all-cause mortality, bleeding-related mortality, or the necessity of surgical or angiographic salvage therapy. OTSC consistently ranked highest across most outcomes in the network ranking estimate.

CONCLUSION

This meta-analysis highlights OTSC as the most effective intervention for reducing 30-day and short-term rebleeding rates in NVUGIB, surpassing both CT and HP, supporting OTSC as a preferred first-line treatment for NVUGIB, while HP and CT remain viable alternatives. Further studies are needed to explore long-term outcomes and cost-effectiveness.

Keywords: Hemostatic methods; Non-variceal upper gastrointestinal bleeding; Over-the-scope-clips; Conventional methods; Hemostatic spray

Core Tip: This systematic review and network meta-analysis compares the efficacy of novel hemostatic interventions-over-the-scope clips (OTSC) and hemostatic powders (HP)-to conventional endoscopic therapy computed tomography (CT) for non variceal upper gastrointestinal bleeding (NVUGIB). OTSC demonstrated superior efficacy in reducing 30-day and short-term rebleeding rates, ranking as the most effective intervention. HP provided a moderate benefit but did not surpass CT. These findings support OTSC as a first-line treatment for high-risk NVUGIB, while HP remains a viable adjunct.