Review for 10.1186/s12876-025-03894-z (2025)

Title: Assessment of the Impact of Power Business Intelligence on Adenoma Detection Rate:
A Prospective Observational Trial
Version: 2 Date: 24 Feb 2025
Reviewer:  Liwen Yao
Reviewer's report:
This study provides a well-organized evaluation of the impact of using Power BI for real-time
feedback on ADR in colonoscopy, demonstrating that while overall ADR did not significantly
change in a high-performing institution, low-performing endoscopists may benefit from such
targeted feedback. However, the observational design and potential confounders limit the
strength of the conclusions, indicating that further controlled studies are needed to confirm these
findings. Moreover, there are several issues need to be solved in the current submission:
Major:
1.The study is introduced as a "prospective observational study" at the beginning; however, the
control group data are from 2021 and are historical. It is recommended to clearly state in the
Methods section that the 2022 data were collected prospectively, while the control group data
were collected retrospectively. This design may introduce selection or information bias, and its
limitations need to be discussed.
2.The study lacks a randomized control group. It is recommended to explicitly acknowledge this
design limitation in the discussion.
3.The specific implementation details of the Power BI feedback intervention are not clearly
described. It is recommended to provide detailed information on the frequency of the
intervention, the content of the feedback, the operational procedures, and whether any other
interventions (such as training or equipment updates) were concurrently implemented, in order
to assess its independent effect.
4.Although the manuscript states that patients under 40 years of age, inpatient or emergency
colonoscopies, and cases without standard bowel preparation are excluded, the specific criteria
for "standard bowel preparation" are not described in detail.
5.The manuscript mentions the use of chi-square tests, Mann-Whitney U tests, and logistic
regression, but it does not specify whether corrections for multiple comparisons were applied
or whether model goodness-of-fit was assessed. It is recommended to provide further details on
how potential confounding factors and multiple comparisons were addressed in the statistical
analysis.
6.The current conclusions may be overreaching. It is recommended to revise the wording
to emphasize that this study only reveals observational associations rather than strict causal
relationships.
7.The conclusion should clearly state the study’s limitations (such as being a single-center,
non-randomized design with incomplete control of confounding factors) and suggest that future
multicenter randomized controlled trials are needed to further validate the effect of Power BI.
Minor:
1.In the phrase “...comparing the data from 2022 (With Power BI group)with the data
from 2021(Without Power BI group)”, there is a lack of space between “group)with” and
“2021(Without”. It is recommended to insert appropriate spaces after and before parentheses to
ensure smooth readability.
2.The term “adeoma” should be corrected to “adenoma”; “feedabck” should be corrected to
“feedback”; and “behabior” should be corrected to “behavior”. A thorough proofreading of the
manuscript is recommended to ensure correct spelling of technical and common terms.