Yen AW, et al. - Researchers conducted this prospective randomized controlled trial to determine the incomplete resection rates of colorectal lesions removed by underwater resection (UR) compared with conventional resection (CR). They assigned individuals with small (6-9 mm) and large (≥ 10 mm) nonpedunculated lesions to CR (gas-distended lumen) or UR (water-filled, gas-excluded lumen). Four hundred sixty-two eligible polyps (248 UR compared with 214 CR) from 255 individuals have been removed. For UR and CR, low incomplete resection rates can be achieved. Findings suggested that UR is effective and safe by avoiding submucosal injection with the advantage of faster resection and potential cost savings for removing larger (≥ 10 mm) lesions. As an added approach, UR has the potential to enhance colonoscopy's cost-effectiveness by increasing efficiency and cost reduction while maintaining quality.