Underwater hot and cold snare polypectomy can be safely executed during water exchange colonoscopy

Underwater polypectomy without submucosal injection for colorectal lesions ≤ 20 mm in size—a multicenter retrospective observational study

“…Three cases of UWP during insertion WE colonoscopy of smaller sized lesions were initially reported by Ocampo, et al [12], using HSP and CSP, suggesting the possibility of extending UWP with hot and cold techniques to lesions ≤20mm. The observations also raised interests in documenting the expanded role of UWP regardless of the phase of colonoscopic examination (insertion or withdrawal) and the use of various approaches involving HSP, CSP and CFP on commonly encountered lesions.…”

“…Underwater polypectomy (UWP) of large (≥20mm) colorectal lesions was first described in a retrospective observational study from a referral-based practice [4]. Similar reports from other referral centers [5][6][7] and community practice [8] followed, but large polyps account for <5% of colorectal lesions encountered during colonoscopy [9,10] and experience with UWP of lesions ≤20mm in routine practice to date has been limited to a case report [11], small case series [12] and a study with limited number of centers and endoscopists [13], despite the significantly more common occurrence of lesions in this size range. Early observations associated with water exchange (WE) colonoscopy, the simultaneous infusion of clean water and suctioning of turbid effluent and residual stool with gas exclusion, raised interests about further documentation of UWP for lesions of various sizes in routine practice.…”

Incomplete resection after macroscopic radical endoscopic resection of T1 colorectal cancer—should a paradigm-changing approach to address the risk be considered?

“…Water infusion distention provided sufficient space around the polyp for its successful capture by snare, polypectomy and retrieval (13). The underwater resection approach has been extended safely to other pedunculated and nonpedunculated polyps (14) and for salvage resection (15). The ongoing practice of underwater polypectomy by colonoscopists in multiple countries confirm the feasibility and acceptability of the novel approach (16).…”