Hot biopsy forceps technique involves the use of insulated monopolar electrocoagulating forceps to simultaneously biopsy and electrocoagulate tissue. It has been recommended for removal of diminutive polyps and treatment of vascular ectasias of the gastrointestinal tract. The extent of its use and associated complications have not been delineated. This study evaluated the practice of 517 endoscopists. Seventy-one percent (369 endoscopists) used hot biopsy forceps and reported 117 complications, including 85 episodes of bleeding, 19 perforations, and one death. While the overall complication rate was less than that previously reported for colonoscopic polypectomy, 87% of colon perforations occurred on the right side. Factors that may have been important in the development of complications included the degree and length of current application. Adherence to suggested limitations in current application and use of proper technique should result in fewer complications.