S1276 Efficacy of Self-Assembling Peptide in the Primary Treatment of Gastrointestinal Bleeding: A Meta-Analysis

Introduction: Self-assembling peptides (SAP) have been used for hemostasis in mild and moderate bleeding post-endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR), as an adjunct or rescue therapy for venous bleeding, and for prophylaxis to prevent post-procedural hemorrhage. Their use has expanded as primary therapy in various upper and lower gastrointestinal (GI) bleeds, but their efficacy in this setting remains unclear. Methods: We performed a systematic literature search of English language articles in PubMed from inception to May 2025. The pooled proportion and mean difference were calculated by using a random-effect model with 95% CI. Outcomes were assessed with arcsine square root transformation to account for variance stabilization. Heterogeneity was assessed by the Cochrane Q test and the I² statistics. Results: Seventeen publications with 909 patients were included who received therapeutic SAP for GI bleeding. 14% (n = 128) and 9.7% (n = 88) of these patients were on antiplatelets and anticoagulation, respectively. SAP application was technically successful in all patients. In upper GI bleeding (esophagus, stomach, and duodenum), the pooled rate of successful hemostasis was 97.4% (95% CI 96-98.7, I2 = 0), rebleeding was 3.8% (95% CI 1.9-0.56, I2 = 0), and delayed bleeding was 4.2% (95% CI 2.3-6.1, I2 = 0). In lower GI bleeding (colorectal), the pooled rate of successful hemostasis was 97.1% (95% CI 95.1-99.1, I2 = 0), rebleeding was 10.7% (95% CI 6-15.3, I2 = 0), and delayed bleeding was 6.4% (95% CI 2.6-10.3, I2 = 0). Across all GI bleeds, the pooled rate of successful hemostasis was 90% (95% CI: 88-92, I2 = 0), rebleeding was 6.8% (95% CI 4.7-9.1, I2 = 0), and delayed bleeding was 5.3% (95% CI 3-8.3, I2 = 48.7). No adverse events were noted related to SAP application. Conclusion: SAP demonstrates high rates of immediate hemostasis and low rates of rebleeding and delayed bleeding. The rates of successful hemostasis in upper and lower GI bleeds were comparable after SAP application. The rates of rebleeding and delayed bleeding were higher in lower GI bleeds compared to upper GI bleeds after SAP application. Its efficacy is preserved even in patients on antithrombotic therapy. These findings support the safe use of SAP in the therapeutic management of GI bleeding.