Review for 10.1186/1471-230X-13-128 (2013)

Reviewer's report
Title:Accuracy of endoscopic diagnosis of Helicobacter pylori infection according
to level of endoscopic experience and the effect of training.
Version: 1Date:20 March 2013
Reviewer: Masaaki Kobayashi
Reviewer's report:
Major Compulsory Revisions
The authors identified the diagnostic yield of endoscopy for H. pylori infection at
various endoscopist career levels, and concluded that the diagnostic yield was
high for H. pylori-uninfected cases, but was low for H. pylori-eradicated cases.
It is interesting and important, but there are quite number of problems.
Consideration and description are still insufficient.
1.This study included 21 H. pylori-eradicated cases. The duration after
eradication and the degree of mucosal atrophy and metaplasia should be
described. Definitely the diagnostic yield was low for H. pylori-eradicated cases.
It is correlated with recovery of mucosal atrophy and metaplasia as well as
disappearance of inflammation, which are various according to the duration after
eradication.
2.In this study, 11 distinctive endoscopic findings related to H. pylori infection
status (uninfected, infected, and eradicated) were used for analysis. However,
the authors selected six photos of specific sites of the stomach in each case, and
endoscopic findings were then evaluated. The finding of fundic gland polyp,
xanthoma, and motteled patchy erythema were local. The authors selected
photos which showed these local findings?
3.The authors concluded that accuracy was low in beginners but improved after
two years of training. Extraction of endoscopic findings for the diagnosis of H.
pylori infection status appears to be useful, and the beneficial effects can be
enhanced by training. However, a significant increase was confirmed in
diagnostic yield of H. pylori-uninfected (p<0.05) and H. pylori-eradicated (p<0.05)
in beginner 1 only. In contrast, beginner 2 had high accuracy similar to senior
endoscopitis before training in diagnostic yield of H. pylori-uninfected and H.
pylori-eradicated. If the training effect would be emphasized, more beginners’
data should be evaluated.
4.I am very interesting in differences of clinicopathological findings between
correct and incorrect cases after successful eradication. The authors analyzed
three endoscopic biopsy specimens taken from the greater curvature of the
upper gastric body, angulus, and antrum. Is there a correlation of histological
evidence with the diagnostic yield?
5.Patient characteristics were showed 28 were H. pylori-uninfected, 28 were
-infected, and 21 were –eradicated. Were there any cases without eradication
histroy, but negative for H. pylori or only low level of antibody?
6.Regular arrangement of collecting venules (RAC) is defined as a finding based
on magnifying endoscopy. This study was performed using a high resolution
videoendoscope without magnification.
7.Table 1 showed mean accuracy of 6 physicians for “all physicians”? The
percentages in parenthesis mean 95% CI of diagnostic yield? Table 3 showed
mean kappa values of 6 physicians for “all physicians”?
8.“Olympus Co.” had better be changed to “Olympus Medical Systems”.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.