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The following is a summary of “A cooling off period: decline in the use of hot biopsy forceps technique in colonoscopy in the U.S. Medicare population 2000–2019,” published in the May 2025 issue of BMC Gastroenterology by Read et al. 

The use of hot biopsy forceps with electrocautery had been discouraged due to higher complication rates compared to cold biopsy forceps, but the frequency and trends of its use in the United States (U.S.) remained unclear. Despite being less favored for polyp removal, hot biopsy forceps were still occasionally used in endoscopic procedures that could serve as alternatives to minor surgery for tissue sampling or lesion management. 

Researchers conducted a retrospective study to analyze trends in hot biopsy forceps use by U.S. Medicare providers, identify provider characteristics associated with its use, and assess regional differences. 

They analyzed U.S. Medicare summary data from 2000 to 2019 to evaluate cold and hot biopsy frequencies. Provider and state summary files were reviewed to describe demographics, including geographic region, and to assess regional variation and factors linked to hot biopsy forceps use between 2012 and 2019. 

The results showed that hot biopsy forceps use peaked at 4,12,165 procedures per year in 2003 and declined to 1,08,232 per year by 2019, while cold biopsy forceps use rose from 4,82,862 per year in 2000 to 15,33,558 in 2019. Hot biopsy forceps were more frequently used by non-gastroenterologists and in rural settings. Additionally, a population-adjusted 50-fold variation in use was observed across states, with the highest rates in the southeastern U.S. 

Investigators concluded that regional and provider variations in hot biopsy forceps use indicate opportunities for quality improvement and that de-implementing established endoscopic practices may need distinct strategies from adopting new ones, especially when such procedures are seen as less invasive alternatives to surgery.

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-04020-9