Review for 10.1186/s12876-022-02218-9 (2022)

Reviewer’s report
Title: 
Postpolypectomy fever in patients with serious infection: A report of two
cases
Version: 
1 
Date: 
02 Feb 2022
Reviewer's report:
"PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses one
or several testable research questions? (Brief or other article types: is there a
clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
N/A - no experiments or analyses
STATISTICS - Is the use of statistics in the manuscript appropriate?
N/A - there are no statistics in this study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your
concerns sufficiently for you to now recommend the work as a technically sound
contribution? If not, can further revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: The manuscript entitled "Postpolypectomy fever in
patients with serious infection: A report of two cases and literature review" is a
case report of two patients who developed a fever after a colonoscopy with
polypectomy. This manuscript was previously commented on by four reviewers.
The authors have done well to respond to the prior reviewer's comments and
made changes to the manuscript. The background and discussion sections are
presented in a satisfactory fashion. 
The manuscript is difficult to read and follow due to deficiencies in the "case
presentation" section. This section would benefit from improved organization. I
included several specific comments below. In general, the "case presentation"
section should be broken up into three subsections each with an appropriate title
to improve readability. The first subsection could be called "case selection,
procedures, and definitions." The authors should walk the reader through how
they selected these two cases from 12,000 procedures. This section would give
the inclusion and exclusion criteria. The authors should also include definitions
of fever and serious infection. This subsection should also give the reader an
understanding of routine colonoscopic procedures - are all patients admitted? If
yes, then for how long? Equipment used, and type of sedation. The next
subsection would be "case 1" and it should describe to the reader how the events
unfolded chronologically. Start with the pre-procedure work up, intra-procedure
findings and interventions, and then the post-procedure course including
diagnosis of fever and management.
REQUESTED REVISIONS: 
Specific comments organized by manuscript section:
FIGURES 
Figures 1 and 2: Please crop the images such that the black margins are
removed. No protected health information should appear in the images.
Figure 3: Please include an explanation in the figure legend as to what
abnormality the arrows are highlighting. 
BACKGROUND
Page 2, line 42: change "most common" to "most feared"
Page 2, line 52 and 58: Please define "serious infections" for the reader. Once
defined, then please use this term throughout the text and do not add more
adjectives or descriptors to it. Less variability in the use of ""serious infections""
throughout the manuscript will keep the reader more engaged.
Page 3, line 3: change "study" to "report"
CASE PRESENTATION
I recommend including additional information needed regarding the inclusion
criteria: Were the cases of colonoscopies performed in the outpatient setting
(elective) or inpatient setting (as part of a hospital admission, more urgent)?
Were all post-colonoscopy patients admitted to the hospital routinely in this time
period? If yes, then for how long? What was the timing for assessing a fever
(<24hr, one day, one week, one month) related to a colonoscopy? Was the fever
only assessed while hospitalized or could it be assessed by a patient after
discharge? What temperature threshold used to define fever? 
Individual cases: Why was a CT scan done in these two patients pre-
colonoscopy? Please reorganize the case presentation in a chronological order.
Pre-procedure findings (lack of symptoms, normal labs or imaging) and
indication for colonoscopy should be mentioned at the beginning of each case
and not at the end of the "case presentation" section. Pathology results from any
biopsy or polypectomy should be included at the end of each case presentation.
In case 2, APC was used to treat polyps. Please mention the name of probe and
electrosurgery generator used including settings for the intervention. Did the
patient in case 2 have a transfusion (see pg 4, line 27)? Please briefly describe
the laboratory findings used to diagnose the type 1 respiratory failure in case 2.
Also, please describe the LFT abnormalities in case 2. Did the LFT
abnormalities resolve or worsen during the hospitalization?
ADDITIONAL REQUESTS/SUGGESTIONS: 
Please consider reorganizing the ""Case presentation"" section as noted
previously. The authors should also speculate that the second case with
respiratory failure may have had a viral infection acquired pre-procedure that
manifested only after the procedure completed. It is hard for the reader to
understand why a colonoscopy with minor intervention would lead to respiratory
failure in this case."
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes