Review for 10.1186/s12876-025-03707-3 (2025)

Title: Comparing the bowel cleansing efficacy between sodium picosulfate vs. 2L polyethylene
glycol electrolyte lavage solution for colonoscopy: A prospective observational study
Version: 5 Date: 22 Jan 2025
Reviewer's report:
Abstract
Very nice
Background - getting very close.
"achieved in the majority of the population using a low-volume 2L PEG-ELS regimen (12)" can
we get numbers here?
"It has also been shown that 2L PEG-ELS can be the first choice for people at low risk of
inadequate bowel preparation (13). " not sure what this means.
"Compared to phosphate solutions, " get rid of these words.
Methods - getting close
"box of polyethylene " boxes of ...
"2000 mL of water as a split dose" delete "as a split dose".
"bowel preparation regimen again (Yes or No). etc." etc. is not acceptable. You need to list each
question you asked.
Results - much improved.
Your text is too long and you need to consider shortening it.
"The mean age in the PICO group " should start a new paragraph and begin with "As shown
in Table 1", the only statistically significant differences between the base line characteristics
of the PICO and @L PEG-ELS groups were .... You do not need to list all those that were not
statistically significantly different - they can just look at your table. It will save space. Same
with the rest of the data, just point out the differences and state which table the data is in.
Discussion - much better but still some work to do. I think 1 more revisions and you will be there.
"This prospective observational study found no statistically significant " - remove "This
prospective observational study" and run the first 2 sentences together. It is too repetitive. You
also need to state this is the primary end point of your study.
Why did your study find Total BBPS and right colon segment scores better in the PICO group?
It is because adequate/inadequate measures of bowel cleanliness are crude and less likely to pick
up small, but statistically significant differences in the 2 groups. This is why most study use the
total BBPS as the primary end point.
"At present, low-volume bowel cleansing regimens mainly include 1-2L PEG plus adjuvate,
PICO, oral sulfate solution (10). " you need to give context. Do you mean in China? In the USA,
Gatorade/PEG-3350 is probably the most commonly used low volume prep.
"A randomized, multicenter clinical trial has shown that PICO was comparable to 2L PEG/
Bisacodyl in the bowel cleaning efficacy (97.99% vs. 95.33%, p=0.1093), but may be better in
tolerability (100% vs. 97.67%, p=0.0151) and acceptance (95.99% vs. 44.33%, P<0.0001) (19).
" you need to just talk about cleaning efficacy here (not tolerability which you talk about later).
you need to comment that this finding was c/w with what you find.
"in our previous studies " from China
"Although sleep disturbance was not the primary focus of this study, our findings revealed a
statistically significant disparity between the two groups. Given the current scarcity of pertinent
research, further exploration of this difference is warranted." I would remove this to shorten
the text.
"Previous randomized controlled trials for low-volume bowel preparation were mostly based on
low-risk populations with inadequate bowel preparation (25, 28). " -  I think you mean to say
"populations at low risk for inadequate bowel preparations".
You need to shorten the discussion more. I would consider eliminating:
"This selection bias could influence the results. While randomized controlled trials continue to
be the gold standard, 95% of the patients we prospectively enrolled in this study were included
in the study cohort, aiming to mirror the true clinical scenario as closely as possible. "
Conclusion
1) No significantly significant difference adequate preparations as measured by the BBPS
between groups.
2) PICO better Total and Right segment scores.
3) Less nausea in PICA and more sleep disturbances in 2L PEG-ELS. (as you state nicely).
Eliminate "Despite these differences, the two groups showed similar polyp detection rates,
patient compliance, and a high willingness to repeat bowel preparation." - its just too long.
Table 1 - much nicer
Recheck needs to be better defined, as "history of polyps". You should not have to read the
bottom of the table for this info.
"The proportion of low-risk populations" needs to be better defined or better explained in the
text  below the table. Maybe "No risk factors for suboptimal bowel prep"
Table 2 - nice
Table 3  - nice
Table 4 - ok