Reply to Gao et al.

10.1055/a-2683-7550

We thank Dr. Gao and colleagues for their thoughtful comments on our recently published article [1] and for their interest in this topic. While most of the included studies were from high income countries, the data may nonetheless approximate to real-world practice. In many low income settings, access to colonoscopy, availability of trained personnel, and quality assurance programs remain variable, limiting both service delivery and data generation [2]. Continued efforts to expand endoscopic practice in these regions are important, and we agree that future research should address these gaps.

Regarding the apparent discrepancy in the values of adenoma detection rate (ADR) reported in one of the included studies [3], we clarify that the article reports both the total number of colonoscopies and the ADR. By multiplying these values, we calculated the nearest integer number of colonoscopies with at least one adenoma. Dividing this number by the total procedures yielded an ADR of 27.49%, which was displayed as 27% in the forest plot generated by the R software. The value used for statistical calculations was therefore consistent.

The concern about the timeframe of included studies is pertinent. Advances such as high definition imaging and quality initiatives may contribute to improved performance; however, the included studies varied widely with regard to their year of publication (2004–2022; median 2013) and our analysis showed no significant difference in the inception date of cohorts between studies with low and high detection rates. Although artificial intelligence efficacy has been demonstrated in trials [4], access to such technology is uneven and its real-world impact remains uncertain. Recent evidence has even suggested possible unintended effects, such as endoscopist deskilling [5].

We are grateful for the opportunity to further discuss these issues and concur that future studies should generate meaningful real-world data, ideally through collaborative multinational efforts that not only capture disparities in access and quality but also assess the integration of new technologies into everyday colonoscopy practice.

Publikationsverlauf

Artikel online veröffentlicht:
28. Oktober 2025

• References

• 1 Fernandes C, Estevinho M, Marques Cruz M. et al. Adenoma detection rate by colonoscopy in real-world population-based studies: a systematic review and meta-analysis. Endoscopy 2025; 57: 49-61
• 2 Lee R, Holmes D. Barriers and recommendations for colorectal cancer screening in Africa. Glob Health Action 2023; 16: 2181920
• 3 Hernandez L, Deas TM, Catalano MF. et al. Longitudinal assessment of colonoscopy quality indicators: a report from the Gastroenterology Practice Management Group. Gastrointest Endosc 2014; 80: 835-411
• 4 Barua I, Vinsard DG, Jodal HC. et al. Artificial intelligence for polyp detection during colonoscopy: a systematic review and metaanalysis. Endoscopy 2021; 53: 277-284
• 5 Budzyń K, Romańczyk M, Kitala D. et al. Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study. Lancet Gastroenterol Hepatol 2025; 10: 896-903