# Endoscopic Management of Malignancy-Related Gastrointestinal Bleeding: A Comprehensive Narrative Review

## TL;DR

This review discusses the challenges of managing gastrointestinal bleeding in cancer patients and highlights new endoscopic techniques and technologies that improve outcomes.

## Contribution

The paper synthesizes recent advances in endoscopic management of malignancy-related gastrointestinal bleeding and emphasizes emerging therapeutic strategies.

## Key findings

- Up to 10% of advanced cancer patients experience gastrointestinal bleeding, which is often difficult to control.
- Topical hemostatic powders like TC-325 show the highest rates of immediate bleeding control in malignant cases.
- New endoscopic tools such as over-the-scope clips and contact-free coagulation devices are expanding treatment options.

## Abstract

Malignancy-related gastrointestinal bleeding (GIB) remains a significant clinical challenge, contributing substantially to morbidity, mortality, and healthcare utilization in patients with cancer. Up to 10% of individuals with advanced malignancies develop GIB during their disease, and these episodes are frequently characterized by a high risk of rebleeding and poor long-term hemostatic control. Tumor-associated bleeding typically arises from friable, infiltrative, and highly vascular lesions that respond suboptimally to conventional endoscopic techniques such as thermal coagulation or mechanical clipping. These limitations underscore the need for improved diagnostic accuracy and more reliable therapeutic options. Recent advances in imaging modalities, including contrast-enhanced CT studies, have enhanced the ability to localize and characterize bleeding sources in complex oncologic cases. Parallel developments in endoscopic hemostasis—such as over-the-scope clips and contact-free coagulation devices—have expanded the therapeutic armamentarium for managing malignant bleeding. Clinically, topical hemostatic powders—particularly TC-325—represent a highly effective option for achieving rapid endoscopic hemostasis, supported by the strongest comparative evidence and the highest rates of immediate bleeding control among currently available technologies. In this review, we synthesize contemporary diagnostic approaches to GIB and place particular emphasis on the evolving and emerging therapeutic strategies for malignancy-related bleeding. We also highlight innovative technologies that are reshaping clinical practice and improving management options in this challenging clinical domain.