Review for 10.1186/s12876-025-03695-4 (2025)

Title: Unveiling the Superior Diagnostic Efficacy of Double-Balloon Endoscopy Compared to
Small Intestine Dual-Energy CT Enterography in Small Bowel Crohn's Disease
Version: 1 Date: 24 Dec 2024
Reviewer's report:
The study by Liu Ji et al. is interesting as it evaluates and compares DECTE and DBE in patients
with Crohn’s disease.
However, there are significant methodological issues and ambiguities that limit the study’s
validity and relevance.
Specific Comments:
1. The methodology does not clarify how CD was diagnosed in the patient cohort. Were there
standardized diagnostic criteria or a reference standard used?
2. The whole  study should finally use either the term “suspected CD” or "confirmed/diagnosed
CD", rather than “in the context of CD,” as not all patients were confirmed to have small bowel
CD (SBCD). Clarify whether the population consisted of patients with a prior diagnosis of CD
undergoing an extension study, or undiagnosed patients undergoing evaluation for suspected
CD. The whole study is ambigous about this point.
3.  In the abstract, the sentence: “It included data from 72 CD patients, of whom four underwent
both DECTE and DBE twice within 3 months” is confusing. Instead, state: “The study included
72 patients who underwent both DECTE and DBE, with 4 patients repeating both procedures
within 3 months.” Clarify further details in the main text.
4. The methods section should clearly outline the patient population selected, inclusion/
exclusion criteria, and study design without introducing numerical results. Details such as “81
patients with DBE…” should be moved to the results section.
5. Discuss contraindications for both DECTE and DBE that may have impacted patient selection.
Exclusion criterion 4 appears redundant and should be revised or clarified. Acknowledge that
DECTE and DBE were not compared against gold-standard diagnostic modalities for SBCD,
such as MRI enterography (MRE) or small bowel capsule endoscopy (SBCE). Please add this
topic to discussion.
6. The preparation protocol for DECTE (dietary restrictions and PEG bowel cleansing on the
day before) is unusually intensive for small bowel evaluation. Discuss its rationale and compare
it with the preparation protocols of other modalities. Moreover, describe PEG final liquid
preparation with volumes, when you mention the PEG powder quantity.
7. Oral DBE typically does not require bowel preparation. Explain why this was implemented.
Note that DBE was not blind, as the route was guided by prior DECTE imaging, which could
have influenced its success rate. Explain whether full video recordings of DBE were available
for blinded re-evaluation.
8. Clearly define whether the study population consisted only of patients with confirmed small
bowel CD (L4) or patients with other CD locations (L1, L2, L3). For patients without positive
small bowel findings, explain why they underwent an extension study and whether results were
confirmed with SBCE, MRE, or histology.
9. Including four repeated cases does not make methodological sense unless a significant time
gap existed between the procedures, suggesting the potential for different findings. Otherwise,
these cases should be excluded.
10. Use the standard format “Surname et al.” when citing studies. Avoid repeating extensive
details for studies already mentioned earlier in the text.