Xu BX, Xu CZ, Zhang HY, Chen XJ, Wei BN, Yang C. Personalizing withdrawal time by insertion time to achieve target adenoma detection rate in colonoscopy. World J Gastroenterol 2025; 31(38): 111364 [PMID: 41112006 DOI: 10.3748/wjg.v31.i38.111364]
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08735911
Submitted on:
October 21, 2025, 14:17
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Reader Comments:
This study offers a compelling and innovative exploration of colonoscopy quality, addressing the critical interplay between insertion time and withdrawal duration to optimize adenoma detection rate (ADR). The proposed "insertion-to-withdrawal" paradigm marks a significant departure from fixed withdrawal time standards, advocating for a personalized approach—a novel and practical advancement. The development of a Shiny app to deliver real-time, individualized guidance further enhances its clinical relevance, providing endoscopists with a valuable tool to improve outcomes.
Several aspects warrant deeper consideration. First, the hybrid SVM-XGBoost model's modest discriminative performance (AUC ≈ 0.64) suggests limitations in its current predictive power, likely due to unaddressed variables such as bowel preparation nuances, insertion difficulty, or segment-specific inspection times. Expanding the dataset with multicenter inputs and incorporating these factors could refine its accuracy. Second, while insertion time serves as a proxy for procedural complexity, its validation against objective difficulty scales or video analysis would bolster the mechanistic basis of the findings. Third, the personalized strategy’s generalizability remains untested; prospective multicenter validation across diverse demographics, endoscopist expertise, and regions is essential. Finally, evaluating real-world app adoption and its impact on ADR adherence would provide critical evidence of its efficacy.
Overall, this study lays a robust foundation for data-driven personalization in endoscopy, moving beyond uniform metrics. With further refinement and validation, it has the potential to transform clinical practice significantly.