Title: A Study on the Timing of Small-Bowel Capsule Endoscopy and Its Impact on the
Detection Rate of Bleeding Sources
Version: 1 Date: 29 Mar 2025
Reviewer's report:
I have read with interest the paper by Kametaka et al. It is a retrospective analysis of the
diagnostic yield of SBCE according to the timing of the examination. Authors found no
significant difference in the diagnostic yield across the four time groups evaluated. All the
vascular lesions were found in the examinations performed in the first 14 days following the
bleeding event.
I have some observations:
- The choice of the time frames appears somehow arbitrary. First of all, considering that
European guidelines recommend small bowel examination within 48 hours, I would have
considered including patients who underwent SBCE within 48 hours from presentation (if any)
as a separate group. Secondly, was it really necessary to evaluate 4 different groups? Why not
to consider only “early SBCE” (within 2 weeks”) vs “delayed SBCE” (and, if possible, “very
early/urgent SBCE” – within 48 hours)?
- The paper lacks some clinical data related to the severity of bleeding (Hb at presentation,
syncope at presentation, shock status/hemodynamic instability, need for blood transfusion,
ongoing bleeding…). These data could be particularly useful to better understand the results
of your paper. For example, it may better clarify why vascular lesions were only found in the
first 2 weeks (It is likely that these patients had more severe presentations that lead to an earlier
examination; if this is true, it should be discussed in the paper)
- You should provide a comparison of the different demographic, anamnestic and clinical
characteristics of the different study groups (for example in table 1)
- It is stated that patients with hematemesis were included into the study. However, hematemesis
is a clear sign of upper gastrointestinal bleeding, and I would generally not consider a patient
presented with hematemesis for small bowel study.
- In 17/68 patients with a negative SBCE a bleeding cause outside the small bowel was finally
found. This is not a small percentage (25%), moreover some of the bleeding causes found in
these patient
Should be quite easy to diagnose (duodenal ulcer, gastrojejunal anastomotic ulcers, colonic
diverticula) during standard endoscopic procedures. Did all the patients undergo upper and lower
endoscopy before receiving SBCE? It should be clearly stated in the method section. Were
some of these extra-small bowel findings visible at SBCE (especially the gastric and duodenal
findings?)
- It would be interesting to have post-SBCE follow-up data (how many patients received
an endoscopic or non-endoscopic treatment after a positive SBCE, how many experienced
rebleeding). In particular a rebleeding-rate comparison of the different study group would be
interesting (similar to the analysis provided in the study by Zhao et al. The role of early video
capsule endoscopy in the diagnosis and prognosis of obscure gastrointestinal bleeding: A multi-
center propensity score matching study. JGH doi:10.1111/jgh.15491)
Title: A Study on the Timing of Small-Bowel Capsule Endoscopy and Its Impact on the
Detection Rate of Bleeding Sources
Version: 1 Date: 29 Mar 2025
Reviewer's report:
I have read with interest the paper by Kametaka et al. It is a retrospective analysis of the
diagnostic yield of SBCE according to the timing of the examination. Authors found no
significant difference in the diagnostic yield across the four time groups evaluated. All the
vascular lesions were found in the examinations performed in the first 14 days following the
bleeding event.
I have some observations:
- The choice of the time frames appears somehow arbitrary. First of all, considering that
European guidelines recommend small bowel examination within 48 hours, I would have
considered including patients who underwent SBCE within 48 hours from presentation (if any)
as a separate group. Secondly, was it really necessary to evaluate 4 different groups? Why not
to consider only “early SBCE” (within 2 weeks”) vs “delayed SBCE” (and, if possible, “very
early/urgent SBCE” – within 48 hours)?
- The paper lacks some clinical data related to the severity of bleeding (Hb at presentation,
syncope at presentation, shock status/hemodynamic instability, need for blood transfusion,
ongoing bleeding…). These data could be particularly useful to better understand the results
of your paper. For example, it may better clarify why vascular lesions were only found in the
first 2 weeks (It is likely that these patients had more severe presentations that lead to an earlier
examination; if this is true, it should be discussed in the paper)
- You should provide a comparison of the different demographic, anamnestic and clinical
characteristics of the different study groups (for example in table 1)
- It is stated that patients with hematemesis were included into the study. However, hematemesis
is a clear sign of upper gastrointestinal bleeding, and I would generally not consider a patient
presented with hematemesis for small bowel study.
- In 17/68 patients with a negative SBCE a bleeding cause outside the small bowel was finally
found. This is not a small percentage (25%), moreover some of the bleeding causes found in
these patient
Should be quite easy to diagnose (duodenal ulcer, gastrojejunal anastomotic ulcers, colonic
diverticula) during standard endoscopic procedures. Did all the patients undergo upper and lower
endoscopy before receiving SBCE? It should be clearly stated in the method section. Were
some of these extra-small bowel findings visible at SBCE (especially the gastric and duodenal
findings?)
- It would be interesting to have post-SBCE follow-up data (how many patients received
an endoscopic or non-endoscopic treatment after a positive SBCE, how many experienced
rebleeding). In particular a rebleeding-rate comparison of the different study group would be
interesting (similar to the analysis provided in the study by Zhao et al. The role of early video
capsule endoscopy in the diagnosis and prognosis of obscure gastrointestinal bleeding: A multi-
center propensity score matching study. JGH doi:10.1111/jgh.15491)
Please review this paper.
user
Title: A Study on the Timing of Small-Bowel Capsule Endoscopy and Its Impact on the
Detection Rate of Bleeding Sources
Version: 1 Date: 29 Mar 2025
Reviewer's report:
I have read with interest the paper by Kametaka et al. It is a retrospective analysis of the
diagnostic yield of SBCE according to the timing of the examination. Authors found no
significant difference in the diagnostic yield across the four time groups evaluated. All the
vascular lesions were found in the examinations performed in the first 14 days following the
bleeding event.
I have some observations:
- The choice of the time frames appears somehow arbitrary. First of all, considering that
European guidelines recommend small bowel examination within 48 hours, I would have
considered including patients who underwent SBCE within 48 hours from presentation (if any)
as a separate group. Secondly, was it really necessary to evaluate 4 different groups? Why not
to consider only “early SBCE” (within 2 weeks”) vs “delayed SBCE” (and, if possible, “very
early/urgent SBCE” – within 48 hours)?
- The paper lacks some clinical data related to the severity of bleeding (Hb at presentation,
syncope at presentation, shock status/hemodynamic instability, need for blood transfusion,
ongoing bleeding…). These data could be particularly useful to better understand the results
of your paper. For example, it may better clarify why vascular lesions were only found in the
first 2 weeks (It is likely that these patients had more severe presentations that lead to an earlier
examination; if this is true, it should be discussed in the paper)
- You should provide a comparison of the different demographic, anamnestic and clinical
characteristics of the different study groups (for example in table 1)
- It is stated that patients with hematemesis were included into the study. However, hematemesis
is a clear sign of upper gastrointestinal bleeding, and I would generally not consider a patient
presented with hematemesis for small bowel study.
- In 17/68 patients with a negative SBCE a bleeding cause outside the small bowel was finally
found. This is not a small percentage (25%), moreover some of the bleeding causes found in
these patient
Should be quite easy to diagnose (duodenal ulcer, gastrojejunal anastomotic ulcers, colonic
diverticula) during standard endoscopic procedures. Did all the patients undergo upper and lower
endoscopy before receiving SBCE? It should be clearly stated in the method section. Were
some of these extra-small bowel findings visible at SBCE (especially the gastric and duodenal
findings?)
- It would be interesting to have post-SBCE follow-up data (how many patients received
an endoscopic or non-endoscopic treatment after a positive SBCE, how many experienced
rebleeding). In particular a rebleeding-rate comparison of the different study group would be
interesting (similar to the analysis provided in the study by Zhao et al. The role of early video
capsule endoscopy in the diagnosis and prognosis of obscure gastrointestinal bleeding: A multi-
center propensity score matching study. JGH doi:10.1111/jgh.15491)
assistant