Jovanovic P. Insertion time as a proxy for procedural complexity: Refining its role in predictive models of adenoma detection. World J Gastroenterol 2025; 31(47): 114092 [DOI: 10.3748/wjg.v31.i47.114092]
Corresponding Author of This Article
Predrag Jovanovic, PhD, Associate Professor, Chief Physician, Consultant, Head, Faculty of Medicine, Department of Internal Medicine, University of Tuzla, Univerzitetska 1, Tuzla 75000, Tuzla Canton, Bosnia and Herzegovina. predrag.jovanovic@untz.ba
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Gastroenterology & Hepatology
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 21, 2025 (publication date) through Dec 19, 2025
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Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Jovanovic P. Insertion time as a proxy for procedural complexity: Refining its role in predictive models of adenoma detection. World J Gastroenterol 2025; 31(47): 114092 [DOI: 10.3748/wjg.v31.i47.114092]
World J Gastroenterol. Dec 21, 2025; 31(47): 114092 Published online Dec 21, 2025. doi: 10.3748/wjg.v31.i47.114092
Insertion time as a proxy for procedural complexity: Refining its role in predictive models of adenoma detection
Predrag Jovanovic
Predrag Jovanovic, Faculty of Medicine, Department of Internal Medicine, University of Tuzla, Tuzla 75000, Tuzla Canton, Bosnia and Herzegovina
Predrag Jovanovic, Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla 75000, Tuzla Canton, Bosnia and Herzegovina
Author contributions: Jovanovic P designed the research, performed the analysis, and wrote the manuscript; and the author has read and approved the final manuscript.
Conflict-of-interest statement: The author declares no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Predrag Jovanovic, PhD, Associate Professor, Chief Physician, Consultant, Head, Faculty of Medicine, Department of Internal Medicine, University of Tuzla, Univerzitetska 1, Tuzla 75000, Tuzla Canton, Bosnia and Herzegovina. predrag.jovanovic@untz.ba
Received: September 11, 2025 Revised: September 18, 2025 Accepted: November 4, 2025 Published online: December 21, 2025 Processing time: 99 Days and 3.5 Hours
Abstract
Existing literature indicates that prolonged insertion time is associated with procedural complexity and may influence adenoma detection. Xu et al recently reported that longer insertion time correlates with lower adenoma detection, but this effect can be mitigated by sufficient withdrawal duration. Insertion time should not be regarded merely as a numeric variable but rather as a multidimensional marker of technical difficulty. Integrating the insertion-to-withdrawal ratio with composite indicators such as looping or bowel preparation quality may enhance predictive models of colonoscopy performance. Conceptualizing insertion time in this way provides a more nuanced understanding of its role in adenoma detection and highlights the need for improved frameworks that link procedural complexity with quality outcomes.
Core Tip: Insertion time is not merely duration but a marker of procedural complexity. Clinicians should view prolonged insertion time as a potential risk factor for reduced adenoma detection, unless offset by adequate withdrawal. Predictive models that incorporate insertion-to-withdrawal ratios and established quality benchmarks may better guide colonoscopy performance and improve outcomes in colorectal cancer prevention.
