Review for 10.1186/1471-230X-12-75 (2012)

Reviewer's report
Title:AFI facilitates the detection rate of colon adenoma, particularly flat &
depressed adenoma, for less-experienced endoscopists, but not for specialists
Version: 1Date:5 January 2012
Reviewer: Gianluca Rotondano
Reviewer's report:
Major Compulsory Revisions
This a prospective study carried out in a single endoscopy unit. Please provide
reason(s) why authors decided to randomize the first operator that performed tha
examination under standard HRE white light vision. Indicate the method of
randomization (computer generated list or sealed envelops or else) and clarify
whether all patients were examined first by an experienced endoscopist (with
either HRE or AFI) and then by a less experienced operator with both HRE and
AFI, otherwise the comparison is overly flawed
Also please state what was considered as the diagnostic gold standard as
accuracy should be calculated against it.
Please provide a flow diagram of the study that is the number of patients eligible
for the study, the inclusion criteria and the esclusion criteria that led to the final
88 patients
Fianlly, provide reason for performing only rectosigmoidoscopy. Were these
patients submitted to a total colonoscopy with HRE and then included in the
study by examining only the distal part of the colon with HRE vs AFI ? Clarify the
issue
Minor Essential Revisions
1. introduction is too long and contains review of the literature usually reserved
for the discussion section. Please shorten and focus it on the general
background of the study
2. the aim of the study shoud be made more clear. That is the sentence should
be" the primary aim of the study was to assess the efficacy of AFi in improving
colorectal adenoma detection rate comparing experienced and less experienced
endoscopist".
3. do not label experienced endoscopst as "specialists" since also less
experienced operators are specialists but simply identify the formers as
"experienced" and the latter as "less experienced" endoscopists
4. there are several problems with english language especially in the methods
section, please consider revising the paper by a native english speaking person
5. definition of "experienced" vs "less experienced" is arbitrarily made and not
validated. Please acknowledge it in the methods section
6. in the methods section please define the population: indications for the
colonoscopy (symptoms vs. screening vs. surveillance), clinical features (gender,
mean age) and add a descriptive table with clinical and endoscopic features (size
of the lesions, polypoid or non polypoid or LSTs) of the studied subjects
7. Title should be corrected avoiding abbreviations (AFI should be
autofluorescence imaging). THis could reasonably be "Autofluorescence imaging
improves the detection rate of colonic adenomas for less experienced
endoscopists".
8. Results section: first sentence should be "HRE examination was performed
by..."
9.provide data on the bowel preparation and degree of colon cleansing
10. methods: avoid the term "polyp" and use the term "lesions" since non
polypoid lesions are elevated (0-IIa) or flat (0-IIb) or depressed (0-IIc) as
categorized by the Paris classification
11. were the detected lesions biopsied or removed (polypectomy/mucosectomy)
for histological analysis. Please clarify this issue which is of paramount
importance. Blinded pathologist evaluation is
of value but indicate whether the original or revised Vienna classification for GI
intraepithelial neoplasia was used (see Dixon et al Gut 2002)
12. discussion: avoid referencing in parentheses papers in press but add them to
the reference list if considered to be important. English language should be
substantially improved. Please focus the discussion on the results of the study
compared to other similar experiences more than on the technical aspects of the
AFI procedure. Discuss also the possible role of NBI as a technique to improve
AFI specificity. Also, please add a section to acknowledge the limitations of the
study.
13 references: ref #4 please correct style with surnames followed by names
(Winawer SJ et al). consider adding the paper by Rotondano et al recently
published in Int J Colorect Dis 2011 on the same issue
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
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'