Title: A Cooling Off Period: Decline in the Use of Hot Biopsy Forceps Technique in
Colonoscopy in the U.S. Medicare Population 2000-2019
Version: 3 Date: 13 Mar 2025
Reviewer's report:
Read et al. have provided an interesting review on the evolution of the use of hot biopsy
technique for colonoscopy amongst providers in the US. The study is appropriately designed to
provide a general overview of provider trends and provides an expected finding (i.e. that the use
of hot biopsy technique is decreasing) given updated guideline recommendations.
The authors provide some interesting insights primarily in the fact that hot biopsy technique
appears to still be utilized amongst some providers and has variation patterns that could be
capitalized on for QI interventions. However, the findings are significantly limited by the lack of
procedure and patient-level data to put these findings into context. The authors do acknowledge
these limitations in their text, however this limitation significantly confounds the conclusions
(e.g. how many of these techniques were being used "inappropriately" for polypectomy purposes
vs other reasons such as hot avulsion of EMR scar sites/treatment of bleeding/etc.).
Some other concerns are:
1. It would be valuable to stratify and include the median volume of colonoscopies performed
by providers and assess if provider volume has a relationship with the use of this technique,
as well as the proportion of colonoscopies for which providers are utilizing this technique. I.e.
even though some providers are still using this technique, is it being used in a relatively small
proportion of cases?
2. In addition to trends in the absolute # and ratio of cold vs hot forceps biopsy forceps over the
years, it would be valuable if the authors could stratify these trends at a provider level to add
further perspective. I.e. what is the trend of the proportion of providers performing cold biopsy
only over the years vs. continuing the use of hot forceps in their practice?
3. Could variations in medicare enrollment/utilization between states explain some of the
variations seen in the analysis?
4. Please clarify if the analysis from table 2 based off of data from the most recent year of the
database (i.e. 2019)? It may be interesting to have a similar analysis from older years (i.e. 2000)
to see if the provider characteristics were similar at that time vs. recent day.
Title: A Cooling Off Period: Decline in the Use of Hot Biopsy Forceps Technique in
Colonoscopy in the U.S. Medicare Population 2000-2019
Version: 3 Date: 13 Mar 2025
Reviewer's report:
Read et al. have provided an interesting review on the evolution of the use of hot biopsy
technique for colonoscopy amongst providers in the US. The study is appropriately designed to
provide a general overview of provider trends and provides an expected finding (i.e. that the use
of hot biopsy technique is decreasing) given updated guideline recommendations.
The authors provide some interesting insights primarily in the fact that hot biopsy technique
appears to still be utilized amongst some providers and has variation patterns that could be
capitalized on for QI interventions. However, the findings are significantly limited by the lack of
procedure and patient-level data to put these findings into context. The authors do acknowledge
these limitations in their text, however this limitation significantly confounds the conclusions
(e.g. how many of these techniques were being used "inappropriately" for polypectomy purposes
vs other reasons such as hot avulsion of EMR scar sites/treatment of bleeding/etc.).
Some other concerns are:
1. It would be valuable to stratify and include the median volume of colonoscopies performed
by providers and assess if provider volume has a relationship with the use of this technique,
as well as the proportion of colonoscopies for which providers are utilizing this technique. I.e.
even though some providers are still using this technique, is it being used in a relatively small
proportion of cases?
2. In addition to trends in the absolute # and ratio of cold vs hot forceps biopsy forceps over the
years, it would be valuable if the authors could stratify these trends at a provider level to add
further perspective. I.e. what is the trend of the proportion of providers performing cold biopsy
only over the years vs. continuing the use of hot forceps in their practice?
3. Could variations in medicare enrollment/utilization between states explain some of the
variations seen in the analysis?
4. Please clarify if the analysis from table 2 based off of data from the most recent year of the
database (i.e. 2019)? It may be interesting to have a similar analysis from older years (i.e. 2000)
to see if the provider characteristics were similar at that time vs. recent day.
Please review this paper.
user
Title: A Cooling Off Period: Decline in the Use of Hot Biopsy Forceps Technique in
Colonoscopy in the U.S. Medicare Population 2000-2019
Version: 3 Date: 13 Mar 2025
Reviewer's report:
Read et al. have provided an interesting review on the evolution of the use of hot biopsy
technique for colonoscopy amongst providers in the US. The study is appropriately designed to
provide a general overview of provider trends and provides an expected finding (i.e. that the use
of hot biopsy technique is decreasing) given updated guideline recommendations.
The authors provide some interesting insights primarily in the fact that hot biopsy technique
appears to still be utilized amongst some providers and has variation patterns that could be
capitalized on for QI interventions. However, the findings are significantly limited by the lack of
procedure and patient-level data to put these findings into context. The authors do acknowledge
these limitations in their text, however this limitation significantly confounds the conclusions
(e.g. how many of these techniques were being used "inappropriately" for polypectomy purposes
vs other reasons such as hot avulsion of EMR scar sites/treatment of bleeding/etc.).
Some other concerns are:
1. It would be valuable to stratify and include the median volume of colonoscopies performed
by providers and assess if provider volume has a relationship with the use of this technique,
as well as the proportion of colonoscopies for which providers are utilizing this technique. I.e.
even though some providers are still using this technique, is it being used in a relatively small
proportion of cases?
2. In addition to trends in the absolute # and ratio of cold vs hot forceps biopsy forceps over the
years, it would be valuable if the authors could stratify these trends at a provider level to add
further perspective. I.e. what is the trend of the proportion of providers performing cold biopsy
only over the years vs. continuing the use of hot forceps in their practice?
3. Could variations in medicare enrollment/utilization between states explain some of the
variations seen in the analysis?
4. Please clarify if the analysis from table 2 based off of data from the most recent year of the
database (i.e. 2019)? It may be interesting to have a similar analysis from older years (i.e. 2000)
to see if the provider characteristics were similar at that time vs. recent day.
assistant