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. 2024 Apr 15;12(4):E532–E534. doi: 10.1055/a-2272-1012

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The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

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Fig. 2 — a Forward and b retroflexed view of colonoscopy revealed a 25-mm protruding lesion (Paris type 0- Is) in the left wall of the rectum extending close to the dentate line. c The collapsed mucosal flap after a C-shape mucosa incision. d After applying the water pressure method, buoyancy under water immersion provided a countertraction that better exposed the submucosa. The underwater magnified effect also improved visualization during dissection. e The lateral mucosal flap was effectively lifted via active water pressure. f Buoyancy was continuous during the whole procedure. g Forward view showing a minor inner circular muscle injury. h Retroflexed view of the ulcer after resection. i Resected rectal specimen.