Title: Efficacy of Sigmoidoscopy for Evaluating Disease Activity in Patients with Ulcerative
Colitis
Version: 2 Date: 11 Dec 2021
Reviewer's report:
The study on the concordance of endoscopic activity between the distal and proximal parts of
the colon in ulcerative colitis is clinically significant, because colonoscopy is associated with
the burden and risk to patients. And the high rate of concordance between the two is a clinically
important result.
However, it is judged that the following points need to be reconsidered and the contents revised.
The purpose of this study is to investigate the homology of endoscopic activity between the
distal and proximal portions of the colon in patients with ulcerative colitis.
(1) Therefore, it is more appropriate to classify the types of ulcerative colitis into proctitis type,
distal colitis type, left-sided colitis type, and total colitis type, and to study patients with total
colitis and left-sided colitis types, excluding proctitis and distal colitis types.
This is because in ulcerative colitis, especially in proctitis type, distal colitis type, and left-sided
colitis type, skip lesion and appendiceal lesion may be observed, but in general, most lesions are
not observed in the colon more proximally than the continuous lesion.
(2) For the proctitis and distal colitis types, it is preferable to show the proportion of patients
with gross skip lesions or appendiceal lesions in the colon more proximally than the sigmoid
or descending colon and the proportion of patients with proximal expanded lesions at the time
of relapse, and to describe the correlation between the main lesion in the distal colon and the
proximal lesion for those cases.
3) The authors also mentioned in their discussion that there is a possibility of selection bias
in this study for severe cases where full colonoscopy observation is difficult. In severe cases
of ulcerative colitis requiring hospitalization, rectal sparing and more worsen lesions in the
proximal colon are often present.
Therefore, it is desirable to clarify whether colonoscopy is performed in an inpatient or outpatient
setting. In addition, if possible, clinical disease activity at the time of colonoscopy, such as Mayo
score, is expected to be shown for flare-up cases.
Title: Efficacy of Sigmoidoscopy for Evaluating Disease Activity in Patients with Ulcerative
Colitis
Version: 2 Date: 11 Dec 2021
Reviewer's report:
The study on the concordance of endoscopic activity between the distal and proximal parts of
the colon in ulcerative colitis is clinically significant, because colonoscopy is associated with
the burden and risk to patients. And the high rate of concordance between the two is a clinically
important result.
However, it is judged that the following points need to be reconsidered and the contents revised.
The purpose of this study is to investigate the homology of endoscopic activity between the
distal and proximal portions of the colon in patients with ulcerative colitis.
(1) Therefore, it is more appropriate to classify the types of ulcerative colitis into proctitis type,
distal colitis type, left-sided colitis type, and total colitis type, and to study patients with total
colitis and left-sided colitis types, excluding proctitis and distal colitis types.
This is because in ulcerative colitis, especially in proctitis type, distal colitis type, and left-sided
colitis type, skip lesion and appendiceal lesion may be observed, but in general, most lesions are
not observed in the colon more proximally than the continuous lesion.
(2) For the proctitis and distal colitis types, it is preferable to show the proportion of patients
with gross skip lesions or appendiceal lesions in the colon more proximally than the sigmoid
or descending colon and the proportion of patients with proximal expanded lesions at the time
of relapse, and to describe the correlation between the main lesion in the distal colon and the
proximal lesion for those cases.
3) The authors also mentioned in their discussion that there is a possibility of selection bias
in this study for severe cases where full colonoscopy observation is difficult. In severe cases
of ulcerative colitis requiring hospitalization, rectal sparing and more worsen lesions in the
proximal colon are often present.
Therefore, it is desirable to clarify whether colonoscopy is performed in an inpatient or outpatient
setting. In addition, if possible, clinical disease activity at the time of colonoscopy, such as Mayo
score, is expected to be shown for flare-up cases.
Please review this paper.
user
Title: Efficacy of Sigmoidoscopy for Evaluating Disease Activity in Patients with Ulcerative
Colitis
Version: 2 Date: 11 Dec 2021
Reviewer's report:
The study on the concordance of endoscopic activity between the distal and proximal parts of
the colon in ulcerative colitis is clinically significant, because colonoscopy is associated with
the burden and risk to patients. And the high rate of concordance between the two is a clinically
important result.
However, it is judged that the following points need to be reconsidered and the contents revised.
The purpose of this study is to investigate the homology of endoscopic activity between the
distal and proximal portions of the colon in patients with ulcerative colitis.
(1) Therefore, it is more appropriate to classify the types of ulcerative colitis into proctitis type,
distal colitis type, left-sided colitis type, and total colitis type, and to study patients with total
colitis and left-sided colitis types, excluding proctitis and distal colitis types.
This is because in ulcerative colitis, especially in proctitis type, distal colitis type, and left-sided
colitis type, skip lesion and appendiceal lesion may be observed, but in general, most lesions are
not observed in the colon more proximally than the continuous lesion.
(2) For the proctitis and distal colitis types, it is preferable to show the proportion of patients
with gross skip lesions or appendiceal lesions in the colon more proximally than the sigmoid
or descending colon and the proportion of patients with proximal expanded lesions at the time
of relapse, and to describe the correlation between the main lesion in the distal colon and the
proximal lesion for those cases.
3) The authors also mentioned in their discussion that there is a possibility of selection bias
in this study for severe cases where full colonoscopy observation is difficult. In severe cases
of ulcerative colitis requiring hospitalization, rectal sparing and more worsen lesions in the
proximal colon are often present.
Therefore, it is desirable to clarify whether colonoscopy is performed in an inpatient or outpatient
setting. In addition, if possible, clinical disease activity at the time of colonoscopy, such as Mayo
score, is expected to be shown for flare-up cases.
assistant