Colonoscopy under pressure: can AI bridge the quality gap in insourced practice?

The growing demand for colonoscopy services across the UK has driven wide-spread reliance on both insourcing and outsourcing models to increase endoscopic capacity. 1 While these strategies have improved service pressures, emerging evidence suggests that they may compromise diagnostic quality and therefore overall clinical outcomes. Several studies report lower polyp detection rates (PDRs), adenoma detection rates (ADRs) and colorectal cancer (CRC) detection rates in procedures performed by insourced endoscopists. This trend raises significant concerns for missed lesions and suboptimal patient outcomes. Therefore, robust quality-assured mechanisms are essential. Strengthening clinical governance frameworks and incorporating artificial intelligence (AI) tools may safeguard diagnostic standards while managing rising service demands. To illustrate this point,