Underwater Endoscopy: Diving into the Future of Gastrointestinal Endoscopy.

PURPOSE OF REVIEW: With endoscopic advances water/saline have been widely adopted as alternatives for CO2 insufflation in endoscopy and its use has been advocated in wide array of endoscopic procedures, both diagnostic and therapeutic. This review aims to highlight the applications and advantages of underwater endoscopy in comparison to conventional techniques.

RECENT FINDINGS: Underwater endoscopy was initially described with water insertion and water exchange techniques to aid difficult insertions during colonoscopy. Its application has now expanded to U-EMR, U-ESD as well as underwater third space endoscopy, where in many scenarios it has been shown to be superior to conventional endoscopy. Underwater endoscopy offers a new dimension in gastrointestinal endoscopic procedures with various advantages over conventional techniques, rapidly making it the preferred approach for various procedures which could otherwise be challenging.