Efficacy of hemostatic powder for non-variceal gastrointestinal bleeding: a systematic review and meta-analysis of randomized trials

Background: Non-variceal gastrointestinal bleeding (NVGIB) is a critical situation and needs immediate resuscitation therapy. Hemostatic powder (HP) is an effective way to achieve hemostasis. Objectives: This study compares the outcomes of HP and conventional therapies (CT) for NVGIB patients. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Data sources and methods: We searched PubMed, Scopus, and other medical databases up to August 2024. This meta-analysis includes studies that reported data on rebleeding, hemostasis, and hospital stays. Using a random-effect model, we analyzed the odds ratios (OR) of the outcomes between the HP and CT groups. Results: Nine RCTs meeting the inclusion criteria were included in this study, comprising data from 796 patients. HP demonstrated a statistically significant advantage in achieving hemostasis compared to CT, with an OR of 2.73 (95% confidence interval (CI): 1.09–6.80; p = 0.03). However, no significant differences ( p > 0.05) were observed in rebleeding rates (OR: 0.73; 95% CI: 0.36–1.47) or length of hospital stay (mean difference: 1.38 days; 95% CI: −1.18 to 3.93). Secondary outcomes, including mortality, surgical intervention requirements, blood transfusion needs, intensive care unit admissions, transfusion units, and procedure time, also showed no significant disparities between groups. Subgroup analyses based on bleeding etiology revealed enhanced efficacy of HP in cases of tumor-related bleeding. Conclusion: Both HP and CT effectively manage NVGIB with similar rebleeding rates, but HP demonstrates superior immediate hemostasis, offering a critical advantage in acute bleeding control. Meta-analysis registration: This systematic review and meta-analysis was registered at PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ ) with registration number CRD42024523237.