Li C, Liu YQ, Wang HX. Feasibility of a forty-minute post-colonoscopy observation period for diverticular bleeding: Assessing the five per cent plateau model. World J Gastrointest Endosc 2026; 18(3): 115049 [DOI: 10.4253/wjge.v18.i3.115049]
Corresponding Author of This Article
Hong-Xia Wang, MD, Chief Physician, Lecturer, Department of Gastroenterology, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdao North Street, Hohhot 010010, Inner Mongolia Autonomous Region, China. wanghx17807078602@163.com
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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/
Mar 16, 2026 (publication date) through Mar 18, 2026
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Li C, Liu YQ, Wang HX. Feasibility of a forty-minute post-colonoscopy observation period for diverticular bleeding: Assessing the five per cent plateau model. World J Gastrointest Endosc 2026; 18(3): 115049 [DOI: 10.4253/wjge.v18.i3.115049]
World J Gastrointest Endosc. Mar 16, 2026; 18(3): 115049 Published online Mar 16, 2026. doi: 10.4253/wjge.v18.i3.115049
Feasibility of a forty-minute post-colonoscopy observation period for diverticular bleeding: Assessing the five per cent plateau model
Chong Li, Yan-Qi Liu, Hong-Xia Wang
Chong Li, Mailman School of Public Health, Columbia University, New York, NY 10032, United States
Yan-Qi Liu, Hong-Xia Wang, Department of Gastroenterology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010010, Inner Mongolia Autonomous Region, China
Co-first authors: Chong Li and Yan-Qi Liu.
Author contributions: Li C and Liu YQ contributed to the conceptualization, methodology, and investigation, they contributed equally to this article, they are the co-first authors of this manuscript; Wang HX provided resources, supervised the project, and was responsible for project administration; Li C prepared the original draft of the manuscript and handled visualization; Liu YQ and Wang HX contributed to the review and editing of the manuscript; and all authors read and approved the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Hong-Xia Wang, MD, Chief Physician, Lecturer, Department of Gastroenterology, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdao North Street, Hohhot 010010, Inner Mongolia Autonomous Region, China. wanghx17807078602@163.com
Received: October 9, 2025 Revised: November 16, 2025 Accepted: January 6, 2026 Published online: March 16, 2026 Processing time: 158 Days and 2.4 Hours
Abstract
This letter appraises the 5% plateau time model proposed by Ichita et al for colonoscopy in colonic diverticular bleeding. By quantifying stigmata of recent hemorrhage detection in 5-minute intervals, the authors identify an overall 40 minutes observation plateau and computed tomography-stratified targets of 30 minutes, 35 minutes and 40 minutes. We highlight how this approach operationalizes a “time-to-yield” concept and argue that the 40-minute period should be interpreted as a flexible observation floor rather than a rigid rule. We discuss clinical feasibility in the context of patient tolerance, operator factors and guideline-based management of acute lower gastrointestinal bleeding, and propose practical strategies for implementation, including computed tomography-stratified guidance, a 20-25 minutes quality checkpoint, individualized shortening of observation in high-risk patients, and systematic documentation of observation time. Finally, we outline priorities for future validation, such as multi-center outcome studies, analyses of operator learning curves and integration of artificial intelligence-assisted stigmata of recent hemorrhage detection.
Core Tip: This article interprets the 5% plateau time model for colonoscopy in colonic diverticular bleeding and emphasizes that a 40-minute observation period should be treated as a flexible minimum floor rather than a rigid rule. By framing observation time as a “time-to-yield” curve, we propose practical strategies for computed tomography-stratified targets, a 20-25 minutes quality checkpoint, individualized shortening in high-risk patients and structured documentation. These suggestions aim to improve time efficiency and operational quality in the management of acute lower gastrointestinal bleeding.
