Review for 10.1186/1471-230X-14-45 (2014)

Reviewer's report
Title:Confocal laser endomicroscopy in prediction of relapse in patients with
ulcerative colitis
Version: 1Date:26 September 2013
Reviewer: Karel geboes
Reviewer's report:
In the study "Confocal laser endomicroscopy in prediction of relapse in patients
with ulcerative colitis" the authors have examined 43 patients with documented
ulcerative coltis. The aim of the study was to evaluate if confocal laser
endomiscroscopy is reliable in the prediction of relapse. Sensitivity, specificity
and accuracy of CLE in real time diagnosis of active inflammation are 95.7%,
85% and 90.7% respectively. The agreement between CLE and conventional
histology is excellent (kappa value = 0.812)..
The authors conclude that laser endomicroscopy is comparable to conventional
histology.
This is an interesting study cofirming previous suggestions that endomicrosscopy
may be very valuable.
Comments
1 : The study is well illustrated and performed carefully. However, the
presentation of the data is sometimes confusing and would benefit from a
language check.
- Some items need clarification
2 : In the introduction the authors state that : "Currently histological evidence
suggesting active inflammation is the most reliable parameter predicting relapse,
such as basal plasmacytosis on rectal biopsy specimens". this sentence is
somewhat unclear. It should be : Current histological evidence suggests that
active inflammation and basal plasmacytosis in colonic biopsies are the most
reliable parameters for the prediction of relapse".
The authors refer to the paper of Bitton e.a. In their study however, they use the
Geboes Index. While this is a good index expecially for active inflammation,
basal plasmacytois is less clearly defined here. Maybe they should also consult
the following paper : Bessissow T, Lemmens B, Ferrante M, Bisschops R, Van
Steen K, Geboes K, Van Assche G, Vermeire S, Rutgeerts P, De Hertogh G.
Prognostic value of serologic and histologic markers on clinical relapse in
ulcerative colitis patients with mucosal healing. Am J Gastroenterol.
2012;107:1684-92.
3 : Overall, I am not sure if confocal laser endomicroscopy can identify properly
"basal plasmacytosis". I would appreciate a more in depth description of how
they identify both diffuse and focal basal plasma cells
4 : In the introduction the authors discuss "mucosal healing". I would appreciate a
more precise definition. Currently "mucosal healing" is used for an endoscopic
procedure and not confirmed by histology in most trials were the concept is used.
5 : Magnification endoscopy should be "magnifying endoscopy".
6 : Statistics
While the data are interesting, the groups are small. Please comment
7 : Results :
CLE versus histology.
I assume that GI stands for Geboes Index. Please clarify abbreviations.
8 : relapse
"... than those remained quiescent" Than those who remained quiescent.
9 : Would it be possible to present the results of CLE and histology in a table?
10 : References
Check names : for instanc ref 4 : Peyrin-Bioulec or Peyrin-Biroulet
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no competing in terests