Review for 10.1186/s12876-021-01672-1 (2021)

Reviewer’s report
Title: 
Routine colonoscopy may be needed for uncomplicated acute right colonic
diverticulitis
Version: 
2 
Date: 
12 Nov 2020
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?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the 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: HAVE THE AUTHORS RESPONDED
ADEQUATELY TO EACH OF THE QUESTIONS YOU RAISED IN YOUR
COMMENTS 
YES 
the authors have nicely and comprehensively responded to both sets of
reviewers' questions 
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE
MANUSCRIPT 
YES the changes in the manuscript make the argument more clear and
appropriate
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED
MANUSCRIPT
I think 
this is an important paper 
because it shows a 13%incidence of
adenomatous polys in patients with acute right-sided diverticulitis 
and supports
routine follow up colonoscopy which otherwise might not have been suspected .
Also the importance of right sided diverticulitis in the Asian population needs to
be mentioned and discussed, because it is more common.
ADDITIONAL REQUESTS/SUGGESTIONS: 
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD
MAKE 
I have re-read the entire text
1. In the abstract you still use the word "advanced" adenoma line 37 I would
really suggest that you add a very short definition of "advanced adenoma " 
on
line 36 saying 
".those 
>10mm and those containing >25% villous components or
severe dysplasia" the reader cannot determine what you mean without this
defined here
2.lines 65-67 WELL DONE 
THIS NOW IS 
PERFECTLY CLEAR AND IS
IMPORTANT!!!
3. Line 122 can you specify where the diverticulitis were found? I think many
readers would want to know if they were only on the right side or were pan
colonic
4. Line 125 I would change to "was found in one male patient 6 weeks later after
he originally presented to our", 
then on line 127 after the word antibiotics I
suggest that you say" for a presumed diagnosis of uncomplicated right sided
acute diverticulitis" and I would move the next sentience starting with "CT
examination" and move it before the sentence on line 127 starting with "He was
admitted". This is much more clear
5. Line 133 round off the follow up to 680 days too few patients to claim a tenth
of a day!
6. 
Line 139 it sounds like you didn't 
get the results of these other 
patients treated
elsewhere yet on the limitations section lines 209-211 you apparently have these
data-- I would add them here.
7. Lines 142. Why not report the overall incidence of adenoma toys polys in the
<45 versus the >45?year old cohort so that the reader does not have to calculate
it themselves -- 
28/209 (13%) versus 51/121 (42%); 
you are going to make a
statement that all patients with right-sided acute diverticulitis should be
colonoscoped. And by reporting this here it will further support your contention
every reader will probably think that patients less than 45 may not need to be
colonoscoped!
8. Line 152 shouldn't you also report the rates for those < and > 45 years old
here? I really think so!
9. Line 161 
the incidence of acute diverticulitis is greater in Asians. Shouldn't
this be mentioned? There are articles in the literature to support this. The fact
that all your patients were Asian is both a limitation AND a strength I would add
that to the limitations section and add a full paragraph to the discussion stressing
this as an important study for the Asian population- remember not all physicians
reading this will have a totally Asian population and many may have few Asians
-it is in both these groups of physicians where your paper is very important.
10. Line 220 why not end that sentence with "even in those less than 45 years
old who had an incidence of adenomas of 13%" 
11. Table 1 why not also separate out those > and those < 45 years old
Table 2 if I were to calculate "advanced adenomas" from the table it would only
be 2 high grade and 1 severe dysplasia. 
Shouldn't you also have the number of
adenomas with 
>25% villous changes in this table? 
With these changes this will strengthen the your excellent paper!!!!
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