De la progression de l'endoscope à la résection : tous à l'eau ! : Endoscopie sous-marine.

After wide-spreading of carbon dioxid use in endoscopy, underwater procedures are the next big step for the endoscopic technical improvement. In the field of diagnosis, water-assisted colonoscopy is associated with best patient reported outcomes such as pain, but also with higher quality criteria such as cæcal intubation rate, bowel cleanliness and adenoma detection rates. Despite its need for a longer examination duration, water-exchange colonoscopy should be preferred to water-immersion colonoscopy. The better tolerance of water-assisted colonoscopy with excellent outcomes should lead to more examinations without general anesthesia, allowing quicker care for patients. Underwater mucosal resection is a technique of choice, especially for sessile or flat lesions, without prior submucosal injection, providing a distance between the muscular layer and the lesion thanks to flotation effect and the minimal distension of the colonic wall during immersion. Underwater mucosal resection improves the en-bloc resection rate and complete resection rate compared to conventional mucosal resection without increasing the adverse event rate, in particular perforation. This strategy is also feasible and safe in the duodenum. Underwater techniques also reduce the environmental footprint since fewer devices are needed and bacteriological mastered water can be used. [ABSTRACT FROM AUTHOR]