Review for 10.1186/1471-230X-14-187 (2014)

Reviewer's report
Title:Metabolic factors haste colorectal adenoma recurrence
Version:3Date:2 July 2014
Reviewer: Hyoun Woo Kang
Reviewer's report:
This topic may be important in the clinical settings with regard to concerning the
interval of surveillance colonoscopy.
However, following questions should be answered and, if possible, changes need
to be made before considering publication.
1. By the present guildelines such as AGA and ESGE guideline, the
recommended interval of surveillance colonoscopy is 3 year or over 5 year
according to the characteristics and number of index adenoma. However, in your
study, large portion of colonoscopies has been done earlier than recommended.
The indications or reasons of earlier colonoscopy should be clarified. (For
example, doctor’s preference). I think your study populations have more
advanced adenomas compared with nonadvanced adenoma in initial
colonoscopy. This may lead to selection bias. So, the generalization of interval
shortening may be impractical. Please explain about this issue.
2. Consider to describe the characteristics of recurrent polyps. The important
point to decide the interval of surveillance is not adenomatous polyp, but
advanced adenoma. The analysis which divides the study population into two
group (group with advanced adenoma recurrence and without recurrence) should
be described.
3. Consider to include metabolic syndrome and central obesity (waist
circumference or waist to hip ratio ) as risk factors of colorectal adenoma, if
possible.
4. Recently, colonoscopic quality indicators such as adenoma detection rates,
withdrawal time and cecal intubation time, are regarded as important issue for
screening and surveillance colonoscopy. Consider to show your data about such
quality indicators and the rate of adequate bowel preparation , if possible. If not,
this is a limitation that should be stated.
Additional comments:
1. Abstract is fine
2. Background is too long. Please, summarize previously known facts, and let
aims follow logically from the information.
3. methods
Young adult (20-49yrs old) should be excluded in this data. Because, they are
not candidates for screening colonoscopy.
In exclusion criteria, why patients with history of appendectomy were excluded?
4. In discussion
In page15, line 10-12: the sentence “Multivariate analysis identified- - - . This
may suggest that the control of current FBG is of important” is not correct. DM
and FBG have direct association, so just one factor should be included in the
multivariate analysis.
In page 16, 12 line: This sentence is also inappropriate.
In table2 , describe how you divide the continuous variables ( Age, BMI, FBG,
HbA1C, LDL-C, TG) into the categorical variables.
Consider to describe which variables were included in this multiple logistic
regression model. Recommend consulting a statician and re-running the
analyses.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests