Review for 10.1186/s12876-014-0196-8 (2014)

Reviewer's report
Title:Adenoma detection rates in an opportunistic screening colonoscopy
program in Iran, a country with rising colorectal cancer incidence
Version:1Date:28 August 2014
Reviewer: Sascha van Doorn
Reviewer's report:
Second review of paper ‘Adenoma detection rates in an opportunistic screening
colonoscopy program in Iran, a country with rising colorectal cancer incidence’ by
Delavari et al
This is a retrospective study evaluating the quality of colonoscopies and its
predictors in an opportunistic screening colonoscopy program.
The current study could potentially very interesting, as it investigates the quality
of colonoscopy in a developing country (Iran), which has not been studies
extensively before.
Overall
The authors have done an excellent job responding to my concerns. Especially
the method section is much clearer now. I only have a few minor comments.
Minor comments
Methods
• The definition of adenomas is now correctly used by the authors. They could
also rename the serrated lesions and divide these in hyperplastic polyps, sessile
serrated adenomas/polyps and traditional serrated adenomas. A suggestion is to
refer to the Vienna classification.
• In the statistical analysis the authors describe that in 109 polypectomy cases
the specimens were sent elsewhere for pathology review. These pathology
results were therefor unavailable for analyses. I was wondering if the authors did
include these polyps in the calculation of the polyp detection rate, they could add
this in the method section. In how many patients were these polyps found, and
how many patients had to be excluded from these analyses?
Results
• The authors responded to my last review and added the adjusted cecal
intubation rate, in which they correct for poor bowel preparation. A suggestion is
to also correct for strictures and stenosis as cause for incomplete procedures,
and use and describe the definition for adjusted and unadjusted cecal intubation
rate.
Discussion
• I would advise to mention the limitations of the study earlier and more clearly in
the discussion.
• Although the authors describe their overall ADR and PDR, it would still be
interesting to describe the ADRs of individual endoscopists, as in done in the
publications they refer to (11,12). The authors mention this as a limitation in the
discussion and write this is due to the small sample size. However, the 713
colonoscopies were performed by 13 endoscopists, and an average of 50
colonoscopies would be enough to calculate individual ADR and PDRs.
Tables
• On page 7 line 19, the authors write ‘The quality indicators are shown in table2’.
However, only detection rates are mentioned in table 2. I would suggest to either
draw one table with all quality indicators and move the preparation quality and
scope progress from table 1 to table 2, as these are also quality indicators, or to
rename the results section ‘Detection rates’ instead of quality indicators.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests