Insertion time as a proxy for procedural complexity: Refining its role in predictive models of adenoma detection

Existing literature indicates that prolonged insertion time is associated with procedural complexity and may influence adenoma detection. Xu <i>et al</i> 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.