S320 Management of Tumor-Related Lower GI Hemorrhage in the Era of Hemostatic Sprays: Are We Making Progress?

Introduction: Gastrointestinal (GI) bleeding is one of the serious and potentially life-threatening complications of colon tumors. Traditional endoscopic hemostatic methods have a low success rate in this setting. Hemostatic powder became available in 2018 and was seen by many as promising in this setting. However, longitudinal data on hemostatic powder real-world treatment outcome is limited. We aim to bridge this gap using the National Inpatient Sample database. Methods: Adult patients with a principal diagnosis of hemorrhage from a benign or malignant colonic tumor were identified yearly from 2016 to 2022. Elective admissions were excluded. The primary outcome was age and sex adjusted in-hospital mortality. Secondary outcomes were 1-treatment modalities: endoscopic therapy, interventional radiology-guided embolization of a vessel (IR Embolization) and extracorporeal radiation therapy, 2-resource utilization: length of stay (LOS), and total hospitalization costs, and charges. Charges and costs were adjusted for inflation using the consumer price index. Results: Overall, 279,541 patients were included in the study. The mean age was 67 years. The majority of patients were White men, of lower income, insured by Medicare and treated at large urban teaching hospitals. From 2016 to 2022, the in-hospital mortality rate increased by 62%. The proportion of patients who received an inpatient colonoscopy steadily decreased by 45%, from 47% to 26%. However, the rate of endoscopic therapy remained constant from 2016 to 2022, and the rate of hemostatic powder use increased 10 folds from 2019 to 2022. Both the extracorporeal radiation therapy rates and IR embolization rates were low and constant over the study period. The mean length of stay increased by 14% over the study period, while the mean total hospitalization costs and charges increased by 18% and 23%, respectively. Conclusion: From 2016 to 2022, the use of endoscopic therapy for colonic tumor hemorrhage remained constant while the use of hemostatic powder increased 10 folds. This rise did not yield any measurable reduction in in-hospital mortality, which trended upward over the study period. The higher rates of endoscopic intervention were associated with increased resource utilization and healthcare costs. These findings highlight the need for more effective and evidence-based modalities to achieve hemostasis in patients with tumor-related colonic bleeding.