Malignant Tumor Bleeding: Is Hemostatic Powder Superior to Standard Endoscopy?

Treating bleeding malignant tumors is challenging because they tend to be diffusely friable. Hemostatic powder is a relatively new tool in the endoscopic armamentarium for treating GI bleeding. Compared with standard endoscopic therapy (SET), data on its use are limited. This multicenter randomized controlled trial aimed to compare hemostatic powder versus SET for efficacy at stopping bleeding. 

Between June 2019 and January 2022, 106 patients with active bleeding from a suspected malignancy were randomized to TC-325 hemostatic powder (n=55) or SET (n=51). Of note, 6 patients were excluded from the final analysis because histology did not confirm malignancy. Both the patient and the outcome assessor were blinded to treatment type. The primary outcome was 30-day rebleeding; secondary outcomes included immediate hemostasis and other clinically relevant endpoints. Baseline characteristics and endoscopic findings were similar between groups. 

The patients treated with TC-325 had a significantly higher immediate hemostasis rate versus the SET group (100% vs 68.6%; odds ratio [OR], 1.45 [0.93-2.29]; P<.001). Additionally, the 30-day rebleeding rate was lower in the TC-325 group versus the SET group (2.1% vs 21.3%; OR, 0.09 [0.01-0.80]; P=.003). There was no statistical difference in the other secondary outcomes. In multivariable analysis, independent predictors of 6-month survival were the Charlson comorbidity index (hazard ratio [HR], 1.17 [1.05-1.32]; P=.008) and patients receiving additional nonendoscopic hemostatic treatment(s) or oncological treatment(s) (HR, 0.16 [0.06-0.43]; P<.001) after adjustment for the functional status, Glasgow-Blatchford score, and source of upper GI bleeding.