A43 TOPICAL HEMOSTATIC AGENTS: A POTENTIAL BREAKTHROUGH IN MALIGNANCY-RELATED GI BLEEDING? A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Bibliographic record
Abstract
Abstract Background Malignancy-related gastrointestinal bleeding (GIB) has been challenging to treat with conventional endoscopic techniques. Topical hemostatic agents (THAs), which do not cause mucosal injury and can be applied over large surface areas, may offer a promising solution in cancer-related GIB. Aims To assess the effectiveness and safety of THAs in malignancy-related GIB compared to conventional endoscopic techniques. Methods We conducted a systematic review using MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials until March 2024. RCTs that compared THA vs conventional endoscopic techniques in malignant GIB were included. Two authors conducted study selection, data extraction and quality assessment independently. The primary outcome was 30-day further bleeding. Further bleeding is a composite outcome of failure to achieve immediate hemostasis and rebleeding. Secondary outcomes included failure to achieve immediate hemostasis, 6-month mortality, 30-day rebleeding, blood transfusions needed, length of hospitalization, and adverse events. RevMan 5.4 was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI, random effects model). Heterogeneity was assessed by Chi 2 (P<0.15) and I 2 tests (>25%). We assessed the certainty of evidence (CoE) for each outcome using the GRADE approach. Results Results: We identified 5100 citations and 4 RCTs with 122 patients were included in the analysis. There was no significant difference between THA and conventional endoscopic methods with respect to 30-day further bleeding through THAs reduce the risk of immediate hemostatic failure. There was no significant difference noted in 30-day rebleeding. THAs did not significantly impact 6-month mortality or blood transfusions. THAs were found to increase the average length of hospitalization by 4.28 days. Conclusions TC-325 appears superior to conventional endoscopic techniques in achieving immediate hemostasis for malignancy-related GIB. It may reduce further bleeding over 30 days as well, but the evidence is very uncertain and further research is needed to assess bleeding risk over this period and beyond. TC-325 did not appear to reduce 6-month mortality. Table 1. Summary of Findings Forest plot of further bleeding Funding Agencies:
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.049 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.025 | 0.038 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".