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."
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
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register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
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
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."
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
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
Please review this paper.
user
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."
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
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
assistant