Review for 10.1186/1471-230X-8-12 (2008)

Reviewer's report
Title:Rebleeding rate after capsule endoscopy for patients with obscure
gastrointestinal bleeding
Version: 1Date:15 February 2008
Reviewer: Diego GARCIA-COMPEAN
Reviewer's report:
The manuscript entitled â##Rebleeding after capsule endoscopy for patients with
obscure gastrointestinal bleedingâ## is a very interesting and well written text
that evaluates the importance of CE for directing interventional therapy in
patients with OGIB . It also evaluates the long term results of this strategy having
as primary target GI rebleeding. Authors of this study found that in the long run
patients with significant findings in CE who received hemostatic therapy have a
significant reduction of rebleeding compared to patients with significant or
insignificant findings who were not treated. In this simple but well structured
study they demonstrated the importance of CE for directing therapy in patients
with high risk of rebleeding.
As authors pointed out this issue has been scarcely studied. Nevertheless some
reports have previously yielded similar results: Garcia- Compean et al (1) and
Delvaux M et al (2) reported identical long term results in patients with OGIB and
positive CE findings who were treated compared to non treated patients.
I have some discretionary and minor comments for authors of this paper:
1. - The title of the manuscript does not reflect entirely the content of the
manuscript. I recommend for example: â##Rebleeding rate after interventional
therapy directed by CE in patients with obscure gastrointestinal bleedingâ##
since modification of the natural history of OGIB was given by the effect of
therapy and not for the CE per se .
2. - Authors excluded patients with swallowing disorders and pacemaker
implantation. I suggest authors to point out in discussion section that these
conditions are no longer contraindications for performance of CE.
3. - Range values of time of follow up and haemoglobin values were not given.
4. - In table 2 definitions of abbreviations should be given in the bottom of the
table. Tables must be auto explained
5. - The diagnostic yield of CE in the study was 95%., although relevant findings
were found in 58%. These relevant findings maybe correspond to the named P2
lesions proposed by some authors (3). Make some comments in discussion
6. - Complications due to procedure and rate of incomplete studies were not
prÃ©cised.
7.- In discussion section in the paragraph of limitations authors may state that
this was not a randomized trial, postherapy values of haemoglobin were not
given.
8.- Finally I suggest authors to include in the manuscript references of published
studies having similar aims and compare their results with those of them.
1.- Garcia-Compean D et al Gastroenterol Clin Biol. 2007; 31:806
2.- Delvaux M et al Endoscopy 2004;36 :1067
3.- Saurin et al Endoscopy 2005 ;37 :318
Please note that both the comments entered here and answers to the questions
below constitute the report, bearing your name, that will be forwarded to the
authors and published on the site if the article is accepted.
What next?
----------
Based on your assessment of the validity of the manuscript, what do you advise
should be the next step?
- Accept after discretionary revisions (which the authors can choose to ignore)
- Accept after minor essential revisions (which the authors can be trusted to
make)
Level of interest
-----------------
- An article of importance in its field
Quality of written English
--------------------------
- Acceptable
Statistical review
------------------
Is it essential that this manuscript be seen by an expert statistician?
- No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests
----------------------------------
I declare that I have no competing intrest