Underwater endoscopic submucosal dissection for large non-pedunculated colorectal polyps

Underwater endoscopic resections have emerged as promising alternatives to the conventional techniques for the treatment of large (≥2 cm) non-pedunculated colorectal polyps; this may also apply to colorectal endoscopic submucosal dissection (ESD) using saline. This retrospective study uses a propensity score-matched analysis of 82/208 such lesions treated during a 3-year period. Underwater ESD using saline improved R0 resection rates (97.6% vs 82.9%), enhanced dissection speed (31.8 mm 2/min vs 22.9 mm2/min) and reduced the use of haemostatic forceps for intraprocedural bleeding (0% vs 14.6%). We recommend this technique to be adopted to facilitate ESD for large non-pedunculated colorectal lesions.