Advancing hemostasis: A meta-analysis of novel vs conventional endoscopic therapies for non variceal upper gastrointestinal bleeding

Table 1 Risk of bias for all the included studies

Study ID	Randomization process	Deviations from intended interventions	Missing outcome data	Measurement of outcomes	Selection of reported results	Overall risk of bias
RCT1	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
RCT2	Low risk	Some concerns	Low risk	Low risk	Low risk	Some concerns
RCT3	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
RCT4	Some concerns	Low risk	Low risk	Low risk	Low risk	Some concerns
RCT5	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
RCT6	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
RCT7	Some concerns	Low risk	Low risk	Low risk	Low risk	Some concerns
RCT8	Low risk	Low risk	Some concerns	Low risk	Low risk	Some concerns
RCT9	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
RCT10	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
RCT11	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
RCT12	Low risk	Some concerns	Low risk	Low risk	Low risk	Some concerns
RCT13	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
RCT14	Some concerns	Low risk	Low risk	Low risk	Low risk	Some concerns
RCT15	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
RCT16	Low Risk	Low risk	Low risk	Low risk	Low risk	Low risk
RCT17	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk

Table 2 Summarizes the results of the pairwise meta-analysis and network meta-analysis across all outcomes

Outcome	Number of studies	Pairwise meta-analysis (OTSC vs CT)	Pairwise meta-analysis (HP vs CT)	Pairwise meta-analysis (OTSC vs HP)	I² (%)	Network meta-analysis (OTSC vs CT)	Network meta-analysis (HP vs CT)	Network meta-analysis (OTSC vs HP)
30-day rebleeding rate	8	0.47 (0.33-0.65)	0.73 (0.45-1.13)	0.56 (0.30-1.05)	0.0	0.41 (0.25-0.63)	0.73 (0.45-1.13)	0.56 (0.30-1.05)
Short-term rebleeding rate	8	0.43 (0.23-0.80)	0.62 (0.28-1.35)	0.59 (0.17-1.67)	0.0	0.35 (0.14-0.74)	0.62 (0.28-1.35)	0.59 (0.17-1.67)
Initial hemostasis rate	8	1.09 (0.99-1.20)	1.13 (0.99-1.35)	1.08 (0.89-1.40)	0.0	1.20 (1.06-1.57)	1.13 (0.99-1.35)	1.08 (0.89-1.40)
Necessity of salvage therapy	8	1.31 (0.66-2.60)	1.41 (0.50-3.95)	0.95 (0.24-3.98)	0.0	1.34 (0.55-3.53)	1.41 (0.50-3.95)	0.95 (0.24-3.98)
All-cause mortality rate	8	0.61 (0.35-1.06)	0.99 (0.51-1.77)	0.55 (0.22-1.45)	0.0	0.54 (0.27-1.06)	0.99 (0.51-1.77)	0.55 (0.22-1.45)
Bleeding-related mortality rate	8	0.37 (0.10-1.34)	0.44 (0.10-1.92)	0.90 (0.07-10.89)	0.0	0.32 (0.05-1.45)	0.44 (0.10-1.92)	0.90 (0.07-10.89)

OTSC: Over-the-scope clips; HP: Hemostatic powder; CT: Computed tomography.

Table 3 Subgroup analysis comparing outcomes of over-the-scope clip therapy vs conventional therapy across different bleeding etiologies

Subgroup	Outcome	Pooled RR (OTSC/CT)	95%CI	P value
Peptic ulcer	30-day rebleeding	0.404	0.292-0.559	0.0001
	Short-term rebleeding	0.434	0.286-0.66	0.0001
	Initial hemostasis	1.016	0.998-1.034	0.0774
	Surgical/TAE necessity	1.122	0.603-2.087	0.7171
	30-day mortality	0.844	0.506-1.406	0.5138
	Bleeding mortality	0.741	0.14-3.922	0.7241
Tumor	30-day rebleeding	0.581	0.322-1.05	0.0719
	Short-term rebleeding	0.47	0.237-0.934	0.0312
	Initial hemostasis	1.04	0.987-1.095	0.1447
	Surgical/TAE necessity	0.697	0.228-2.13	0.5263
	30-day mortality	0.361	0.173-0.753	0.0066
	Bleeding mortality	0.163	0.019-1.383	0.0964
Other	30-day rebleeding	0.5	0.315-0.792	0.0032
	Short-term rebleeding	0.635	0.336-1.201	0.1628
	Initial hemostasis	1.033	0.966-1.105	0.34
	Surgical/TAE necessity	2.154	0.833-5.57	0.1136
	30-day mortality	1.147	0.568-2.314	0.7021
	Bleeding mortality	1.0	0.02-49.913	1.0

Pooled risk ratios with 95%CI and P values are presented for each outcome, stratified by etiology: Peptic ulcer, tumor, and other causes. In peptic ulcer bleeding, Over-the-scope clips (OTSC) significantly reduced both 30-day and short-term rebleeding rates, with no significant difference in initial hemostasis, need for surgical or transarterial embolization, or mortality outcomes. In tumor-related bleeding, OTSC was associated with a significant reduction in short-term rebleeding and 30-day mortality, while other outcomes showed no statistically significant differences. In bleeding from other causes, OTSC significantly reduced 30-day rebleeding but did not significantly affect other outcomes. OTSC: Over-the-scope clips; CT: Computed tomography; RR: Relative risk; TAE: Transarterial embolization.