Review for 10.1186/s12876-021-01923-1 (2021)

Reviewer’s report
Title: 
Follow-up colonoscopy after an abnormal stool-based colorectal cancer
screening result: Analysis of steps in the colonoscopy completion process
Version: 
0 
Date: 
12 Aug 2021
Reviewer's report:
This retrospective study assessed the one-year colonoscopy referral rate of 711
patients who had an abnormal FIT result between August 5, 2017 and August 4,
2018.
No exclusions were applied. Of the 711 patients with an abnormal FIT result,
90% were referred to colonoscopy. 
Outcomes included rates of referral to colonoscopy, completion of a pre-
procedure visit, completion of a follow-up colonoscopy procedure, and time to
follow-up colonoscopy 
completion. Ninety percent of patients with abnormal FIT were referred to a GI
clinic, 52% attended a pre-procedure visit and 43% completed a colonoscopy
within the year following their abnormal FIT result (median time to
colonoscopy: 83 days).
The Authors would encourage health centers to improve follow-up colonoscopy
uptake, in order to reduce time to colonoscopy receipt, and save lives from
colorectal cancer.
Efforts are particularly needed for patients aged 65 and older, those who lack
health insurance, and those who have not attended a clinic visit in the year prior
to an abnormal FIT result.
The paper is clear, fluid and well written. Good statistical analysis.
Colonoscopy is the preferred CRC screening strategy and the undisputed gold
standard in terms of efficacy.
The findings of the study suggest that more than accelerating scheduling delays,
attention should be paid to increase the rate of patients completing a colonoscopy
after an abnormal FIT result.
The intent of the manuscript is noble and remarkable.
On the opposite, the paper lacks of advices/practical recommendations to reach
the goal.
"Improving the documentation of reasons for no follow-up could better inform
future interventions to improve follow-up care".
The Authors raise valid and reasonable questions.
Solutions should be implemented to reach a satisfactory evaluation.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
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Yes
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Yes
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from apparent manipulation?
Yes