Review for 10.1186/s12876-025-04032-5 (2025)

Title: Colorectal Polyp Prevalence and Adenoma Detection Rates in an Iranian Cohort: A
Prospective Study
Version: 0 Date: 15 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The study only includes patients from Tehran, which may limit the generalizability of the results
to the entire Iranian population. Regional differences in diet, lifestyle, and healthcare access
could affect colorectal cancer incidence and screening outcomes.
Further studies incorporating a more diverse geographic and socioeconomic sample would
strengthen the findings.
-The study excludes individuals with a prior history of colon cancer or polyps, inflammatory
bowel disease, and other relevant conditions. While these exclusions are necessary to control for
confounding factors, they may lead to a sample that doesn't fully reflect the broader population
at risk for CRC.
-Additionally, by limiting the study to patients undergoing screening colonoscopies, those with
a higher risk profile (e.g., due to family history) may be underrepresented.
-The study is cross-sectional in nature, relying on a single colonoscopy procedure to assess polyp
and adenoma detection rates. While this provides valuable data, a longer follow-up period would
be useful to assess the long-term outcomes of colonoscopy screening, such as progression to
invasive cancer or recurrence of polyps.
-Even though two experienced GI pathologists conducted pathological assessments, the
possibility of observer bias cannot be ruled out. It would be useful to have a third independent
reviewer or some form of blinded assessment to ensure consistency and reduce subjective
interpretation in histopathological diagnoses.
-The study doesn't appear to account for other potential confounding variables, such as
family history of colorectal cancer, lifestyle factors (e.g., diet, physical activity), and genetic
predispositions, which could influence PDR and ADR. While the exclusion criteria may help
control for some of these factors, their impact on the results remains unaddressed.
-The study mentions low screening participation in Iran but does not explore how this may affect
the overall rates of PDR and ADR. If screening participation is low, it could potentially lead
to a bias toward detecting polyps in individuals who are already symptomatic or at higher risk,
which might skew the detection rates. Discussing how this could impact generalizability to the
broader population would be important.
-While the study mentions the association between longer withdrawal times and higher detection
rates, it could have provided more statistical detail about the magnitude of this association (e.g.,
effect size, and confidence intervals) to enhance the robustness of this argument. This would
give readers a clearer understanding of the strength of the relationship.
-Although the study mentions the prevalence of tubular adenomas as the most common
histological type, it could provide more details on the pathological characteristics of the
detected polyps, such as the proportion of high-risk adenomas or their potential for malignant
transformation. This would be helpful for evaluating the clinical relevance of the polyps and
adenomas detected.