Published online Aug 27, 2026. doi: 10.4240/wjgs.118864
Revised: March 19, 2026
Accepted: May 19, 2026
Published online: August 27, 2026
Processing time: 191 Days and 1.1 Hours
Postoperative bleeding is a common and serious complication of colorectal endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), with reported incidences of 2%-10% and 5%-15%, respectively. Although titanium clip closure is the current standard for wound management, its efficacy is limited for large or irregular wounds. Combining topical thrombin spray with mechanical clip closure may offer synergistic hemostatic benefits, but supporting clinical evidence remains scarce.
To assess the effectiveness and safety of endoscopic thrombin powder spraying combined with titanium clip mechanical suturing in preventing postoperative bleeding following colorectal EMR and ESD.
A clinical study was conducted on 120 patients undergoing colorectal EMR or ESD at the Digestive Endoscopy Center of our hospital from January 2025 to November 2025. Patients were assigned to a study group (n = 59) receiving th
Baseline demographic and clinical characteristics were comparable between the two groups. Regarding bleeding outcomes, total postoperative bleeding rates were 1.7% (1/59) in the study group and 4.9% (3/61) in the control group (P = 0.622), while delayed bleeding occurred in 0% vs 1.6% (1/61), respectively (P = 1.000). Notably, intraoperative hemostasis was achieved more successfully in the study group than in the control group (100% vs 93.4%, P = 0.041). The single delayed bleeding event observed in the control group was minimal and did not require repeat endoscopic hemostasis; neither group necessitated blood transfusion. Postoperative pain scores were significantly lower in the study group at 6 hours, 12 hours, and 24 hours (all P < 0.0125). Additionally, the study group showed a lower Gastrointestinal Symptom Rating Scale total score compared with the control group (10.1 ± 2.1 vs 12.5 ± 2.4, P < 0.001), shorter time to first flatus (16.8 ± 4.2 hours vs 20.3 ± 5.6 hours, P < 0.001), and superior quality-of-life scores across multiple domains at 1 month postoperatively. The rates of en bloc resection and R0 resection were similar between groups (96.6% vs 95.1% and 93.2% vs 91.8%, respectively). No perforation, stricture, or infection was observed in either group.
Endoscopic thrombin powder spraying combined with titanium clip mechanical suturing demonstrates superior efficacy in preventing postoperative bleeding after colorectal EMR and ESD compared to conventional methods, while reducing bleeding severity, improving postoperative recovery, decreasing pain and gastrointestinal symptoms, and enhancing quality of life, without increasing complication risks or compromising oncological outcomes.
Core Tip: This study demonstrates that combining endoscopic thrombin powder spraying with titanium clip mechanical closure provides synergistic hemostasis for colorectal endoscopic mucosal resection and endoscopic submucosal dissection wounds. This dual strategy not only improves intraoperative bleeding control but also reduces postoperative pain, accelerates functional recovery, and enhances early postoperative quality of life without increasing complication risk. The findings suggest that chemical-mechanical hybrid wound management may represent a safer and more effective modality for preventing bleeding after advanced colorectal endoscopic resection.