Review for 10.1186/1471-230X-11-113 (2011)

Reviewer's report
Title:A pilot study of transrectal endoscopic ultrasound elastography in
inflammatory bowel disease
Version: 1Date:27 June 2011
Reviewer: Julio Iglesias-Garcia
Reviewer's report:
- Major Compulsory Revisions
I made the comments following editor guidelines
The question, aim of the article is not directly defined, because authors do not
report exactly the question to be answered, however they state the hypothesis
they want to trust. Manuscript would be improved if they also include the aim of
the study at the end of the introduction
Although authors tried to explain methods in detail, they should emphasize on
which part of the rectum they select for the analysis and why and also if they
select the same are in all cases (anterior, posterior, etc.). Authors should better
explain the exact decision for selecting the reference area for the strain ratio
calculation (see comments regarding the limitations of the study)
Data obtained are well described, both in the text and figures and tables,
although they might thing in including more data at the abstract (strain ratio
results and maybe thickening of rectal wall)
Authors adhere correctly to the relevant standards for reporting and data
deposition.
Discussion and conclusions are well balanced; in fact, I think authors have done
a nice job, with a very good integration of the data in the discussion, giving the
real importance of the study
Although authors tried to establish the limitations of the study, they should
emphasize on more important points:
As commented before, there is a lack of information regarding the selection of
the areas needed for the calculation of strain ratio. A area (lesion, in this case,
the rectal wall) is well defined), however, B area (reference area) is not well
defined, because the select perirectal tissue, and they do not comment if this has
always the same value in all cases, if not the problem is the interference in active
cases of the disease with inflammation, and if this is happening they should
included at the discussion as a limitation, or bias. They do not comment on area
of the rectum they perform the analysis (distance from anum, and which exact
part from the rectum, posterior/anterior…), because values may change. Finally,
performing a rectal study without preparation (at least enema) may induce some
artefacts related to the presence of feces, which may interfere the analysis. All
this point should be included in the discussion, explained.
Regarding the methodology, they should refer to the paper published in
Gastroenterology by Iglesias-Garcia J et al on pancreatic solid lesions, because
the methodology for strain ratio calculation is clearly stated. In fact there is a
certain lack of references on elastographic EUS studies, mainly the one
commented before, published at Gastroenterology
Writing of the article is not only acceptable, its well written (no discussion on this
point)
- Minor Essential Revisions
Authors do not include the meaning of TRUS during the manuscript, and should
be mentioned at the first time (at material and methods, 2º paragraph, 11 line)
- Discretionary Revisions
Authors should better explain (as commented before) the methodology of the
EUS study
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests