Endoscopic removal of colorectal polyps is central to colorectal cancer prevention, with techniques ranging from cold snare polypectomy (CSP) for smaller lesions to hot snare polypectomy (HSP) for selected larger or pedunculated polyps. ESGE guidelines recommend tailoring technique selection to lesion size, morphology, and location. Although effective, these procedures generally require an assistant to actuate the snare. The HOLDFINGER device is a finger-mounted stabilizing system designed to secure the snare handle and may enable autonomous single-operator polypectomy. This study aimed to assess the feasibility and safety of single-operator CSP and HSP using the HOLDFINGER device.

Seven consecutive patients underwent snare polypectomy with the HOLDFINGER device. Procedures were performed autonomously by experienced endoscopists, except one case requiring assistance for submucosal injection and clip placement during HSP of a 20 mm Paris 0-IIa lesion. No patient was on chronic antiplatelet or anticoagulant therapy.Lesions included three flat polyps (two <10 mm; one 20 mm), one sessile polyp (<10 mm), and three pedunculated polyps with heads <15 mm. CSP was used for flat and sessile lesions; HSP for pedunculated lesions and for the 20 mm flat lesion. Locations included three sigmoid, two transverse, and two right-colon lesions. Outcomes included en-bloc and R0 resection, assistance needed, procedure time, and complications.

All lesions were resected en-bloc with R0 margins. Mean procedure time was 6 minutes. One intraprocedural bleeding event during HSP of a pedunculated polyp was controlled with clip placement, with no other intraprocedural or delayed bleeding. Assistant involvement was limited to lifting and clip deployment. No perforation or additional complications occurred.

Single-operator CSP and HSP using the HOLDFINGER device appeared feasible and safe in this small series. Larger studies are required to confirm these findings.