Review for 10.1186/s12876-025-03695-4 (2025)

Title: Unveiling the Superior Diagnostic Efficacy of Double-Balloon Endoscopy Compared to
Small Intestine Dual-Energy CT Enterography in Small Bowel Crohn's Disease
Version: 1 Date: 15 Dec 2024
Reviewer's report:
Your manuscript offers an insightful comparison between dual-energy computed tomography
enterography (DECTE) and double-balloon endoscopy (DBE) for diagnosing Crohn's disease
(CD). This critical clinical topic is particularly relevant as it emphasizes the benefits of combined
diagnostic approaches. While the study is methodologically sound and well-structured, several
areas could benefit from improvement to enhance the findings' clarity, rigour, and impact.
Major Comments
Clarity and Language: The text has awkward phrasing and grammatical errors. A thorough
revision by a (?) professional language editor is recommended to improve overall readability
and scientific clarity. For example:
- "DECTE uses high- and low-energy X-ray data to reconstruct images at a single keV energy."
# Consider rephrasing for simplicity and clarity for a broader audience.
- "During the procedure, patients were sedated with propofol. The procedure was halted if the
intestine proved too narrow to pass through." # This sentence is somewhat disjointed and could
benefit from smoother transitions.
- Clearly define acronyms upon their first mention, including in the abstract (e.g., DBE and
DECTE).
Statistical Reporting: While the manuscript appropriately uses statistical tools, it lacks
confidence intervals (CIs) for diagnostic rates and other comparisons. Including CIs would
enhance clarity and precision for readers evaluating the diagnostic effectiveness of DBE and
DECTE. Additionally, explain the rationale behind specific statistical methods, such as using
the Mann-Whitney U test for non-normally distributed data.
Study Design Limitations: The manuscript briefly acknowledges its retrospective nature but
does not adequately discuss the inherent limitations of this design, such as selection bias and a
lack of control over confounding variables. It would be beneficial to address these limitations
explicitly in the Discussion section. Additionally, explain why multi-centre data were not
included, as this could enhance the generalizability of the findings.
Clinical Relevance: While the manuscript highlights DBE's advantages, it does not sufficiently
address its logistical and clinical limitations, including its invasiveness, patient compliance,
and the availability of skilled operators. A more balanced discussion regarding DECTE's
noninvasive nature and its potential as an alternative for patients who cannot tolerate DBE would
be valuable.
Figures and Tables:
The tables are informative but require consistent formatting. For example:
- In Table 3, clarify whether percentages are calculated based on the total sample size or on
subset populations.
- Table 5 clearly indicate whether P-values refer to comparisons of positive vs. negative groups
within each modality (DBE or DECTE).
- The figure legends need to be more detailed. For instance, in Figure 2, elaborate on the clinical
significance of cobblestone signs, long ulcers, and fistulas.
Minor Comments
Introduction: Include additional background information on the role of DECTE in detecting CD
complications, such as its sensitivity for fistulas or strictures.
Discussion: When referencing prior studies (e.g., Wang et al., Huang et al.), provide more
direct comparisons with the current findings to contextualize the results. Expand on future
research recommendations, mainly focusing on multi-centre prospective studies or developing
non-invasive techniques to complement DBE.
Formatting: Ensure consistent formatting of section headings and subheadings throughout
the manuscript. For example, align the style between “3.1 Diagnostic accuracy” and other
subsections.
Essential Revisions for Acceptance
- Revise the manuscript for clarity and ensure that figures, tables, and statistical reporting meet
journal standards.
- Provide a more detailed discussion of DBE and DECTE's limitations, balancing their strengths
with practical considerations.
- Address the implications of the retrospective design concerning bias and generalizability.
With these revisions, the manuscript will significantly improve in quality and impact, and can
be accepted