ESGE guidelines recommend prophylactic endoloop placement before resecting large pedunculated colonic polyps, but positioning the loop can be technically demanding and may affect procedural safety.

This video presents three cases of endoloop-assisted underwater resection of large pedunculated colonic polyps. Underwater immersion provides buoyancy, lifting the polyp and facilitating accurate endoloop placement. This approach improves stability, precision, and safety, helping reduce the risk of post-polypectomy bleeding. In some cases, water irrigation alone achieved adequate colonic distension, overcoming spasm and rapid CO₂ expulsion.

In conclusion, underwater immersion simplifies endoloop placement and enhances snare capture and resection of large pedunculated colonic polyps.