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 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.