Review for 10.1186/s12876-024-03251-6 (2024)

Title: Risk Factors for Delayed Colorectal Postpolypectomy Bleeding: A Meta-Analysis
Version: 2 Date: 22 Nov 2023
Reviewer's report:
Dear authors,
I am sorry, but I won't recommend your article for publication.
Firstly because I do not think it is well-written, with multiple cases of using inappropriate,
unclear or nonspecific terminology. Apart from the language there is too much data especially
in the result section, which makes it hard to read the manuscript. I would always suggest to
show as much of the data in tables and figures, and only describe the highlights of your results
in you result section.
Scientifically I wonder what the added value of this article is, since multiple meta-analyses have
been published on this topic.  In the background the argument is whether preventive measures
can reduce the risk of DPPB, should require further analysis on the risk factors of DPPB, which
I find a weak argument. If you want to assess preventive measures, you should assess those and
not DPPB.
I also wonder that the majority of included studies are from Asia (only 459 cases from USA / the
Netherlands), and that the flow chart does not explain why articles were removed or excluded
from analysis. I believe the supplementary material should comprise a list of all the articles that
were screened for eligibility and why they were in- or excluded.
It is no surprise that antithrombotic drugs  increase the risk of DPPB, I am missing analyses on
NOAC, since those are very commonly used in Europe, and probably give a higher risk on DPPB.
At least you should describe them in the discussion session, and also why they are not assessed in
this study. Also very relevant would be whether patient have paused their antithrombotic therapy
in regards to local guidelines: are they bleeding because they did not pause their medication,
or are they bleeding even if they paused their medication. I also feel you should discuss this in
the discussion section.
Do you really believe a large/scale prospective clinical randomized controlled study is required
to assess this topic any further? I think that the preventative treatment in the high-risk group as
defined by this study, is a more relevant and interesting topic...
I also think that the supplementary material is probably too much, I don't think all the forest
plots need to be available.
Minor comments:
- I do not know of the regular use of argon plasma coagulation for polypectomy, as far as I know
it is not a common practice in Europe, and as so it should be discussed in your discussion (how
often it is used, when it is indicated, et cetera).
- How high is the risk of mortality after DPPB? I know the risk of mortality after colonoscopy
is very low, so I expect the mortality of DPPB to be very low as well. You always make a better
point, if you support it with concrete data.
- What instructions do you believe male patients did not follow that increase their risk for DPPB?
Be concrete.
- I am not as concerned about the harmony of the doctor-patient relationship, in case of possible
life-threatening complications. I would say that is a minor issue compared to preventing and
treating DPPB.