Clinical efficacy and safety of endoscopic metal titanium clip and local injection hemostasis for acute non-variceal upper gastrointestinal tract bleeding: a meta-analysis.

This meta-analysis systematically evaluated the clinical efficacy and safety of endoscopic metal titanium clips versus local injection hemostasis for acute non-variceal upper gastrointestinal bleeding (ANVUGIB). A comprehensive search of PubMed, Cochrane Library, Embase, Web of Science, CNKI, and Wanfang data was conducted from inception to June 2025, identifying nine randomized controlled trials involving 871 patients. No significant differences were observed between the titanium clip and injection groups regarding initial hemostasis rate (RR = 1.02, 95% CI: 1.00-1.05, P = 0.08), hospitalization time (MD = -0.59 days, 95% CI: -1.75-0.57, P = 0.32), mortality (RR = 1.23, 95% CI: 0.62-2.43, P = 0.56), or blood transfusion volume (MD = -0.35 mL, 95% CI: -0.85-0.14, P = 0.16). However, the titanium clip group demonstrated significantly lower rebleeding rates (RR = 0.58, 95% CI: 0.36-0.92, P = 0.02) and reduced surgical requirements (RR = 0.32, 95% CI: 0.12-0.85, P = 0.02). Subgroup analysis showed that titanium clips were particularly advantageous in reducing rebleeding among peptic ulcer patients (RR = 0.25, P = 0.0008). Sensitivity analysis confirmed the robustness of these findings, and no significant publication bias was detected. In conclusion, while endoscopic metal titanium clips and local injection offer comparable initial hemostatic efficacy and safety for ANVUGIB, titanium clips are superior for reducing rebleeding and the need for surgical intervention, especially in patients with peptic ulcers or a high risk of rebleeding, and should therefore be prioritized as a hemostatic strategy.