Title: Efficacy of Sigmoidoscopy for Evaluating Disease Activity in Patients with Ulcerative
Colitis
Version: 2 Date: 07 Dec 2021
Reviewer's report:
I am very pleased to have been given the opportunity to review this study.
Assessing mucosal status via colonoscopy for the evaluation of disease activity in patients with
ulcerative colitis (UC) is important in guiding treatment decisions, but it is often difficult to
perform total colonoscopy. While this study managed to discuss the evaluation of activity in UC
using colonoscopy, it requires the following considerations and revisions.
Major Comments
Background
#MES stands for Mayo Endoscopic Subscore, not Mayo Endoscopic Score. Please ensure that
this abbreviation is corrected in the main text, abstract, tables, and figures.
Methods
# CRP and fecal calprotectin were evaluated in this study, but there are several methods to
measure fecal calprotectin. Given that this was a multicenter study, please clarify whether a
uniformed approach used to measure fecal calprotectin levels? At what timepoint were CRP and
fecal calprotectin measured?
Results
#Table 1 should also show fecal calprotectin and CRP values for the assessment of UC activity
in all cases. Please provide the clinical activity index if the data are available.
# Multiple colonoscopies have been performed in a single patient. What is the maximum number
of colonoscopies that were performed in a patient?
#In Table 4, what do 0 and 1 in topical 5-ASA represent?
#The MES and UCEIS of 7.6% and 8.6%, respectively, were more severe in the proximal
colon area than in the rectosigmoid colon area. In these cases, however, performing multiple
colonoscopies in the same patient will have a significant influence on the results. Out of the
percentages provided, how many colonoscopy findings were from the same patient?
#It was stated that "as an endoscopic evaluation for disease activity in patients with ulcerative
colitis, MES #2 or UCEIS #5 is evaluated as active disease, and escalation of drugs should be
considered" (Page 7, Line 159). The reference or basis for these endoscopic cutoff values should
be provided in the Methods section.
# Table 4 presents a comparison of cases in which sigmoidoscopy and colonoscopy can be
evaluated. This table presents an important comparison for exploring the factors that require
colonoscopy in this study; it was pointed out that disease extent is an important criterion to
consider, which is also realized in clinical practice. However, this notion is extremely simplistic,
and more criteria should be analyzed to accurately determine which specific factors result in the
need for colonoscopy. Please show the results of other factors such as sex, age, and duration
of illness.
Minor Comments
#The notation in Table 1 should be modified as follows: Male (n, %) # Male, n (%)
#It should be explained what the median age and disease duration of Table 1 are ± 17.78 and
± 48.88, respectively.
#Please indicate the units of CRP and fecal calprotectin in Table 4.
Title: Efficacy of Sigmoidoscopy for Evaluating Disease Activity in Patients with Ulcerative
Colitis
Version: 2 Date: 07 Dec 2021
Reviewer's report:
I am very pleased to have been given the opportunity to review this study.
Assessing mucosal status via colonoscopy for the evaluation of disease activity in patients with
ulcerative colitis (UC) is important in guiding treatment decisions, but it is often difficult to
perform total colonoscopy. While this study managed to discuss the evaluation of activity in UC
using colonoscopy, it requires the following considerations and revisions.
Major Comments
Background
#MES stands for Mayo Endoscopic Subscore, not Mayo Endoscopic Score. Please ensure that
this abbreviation is corrected in the main text, abstract, tables, and figures.
Methods
# CRP and fecal calprotectin were evaluated in this study, but there are several methods to
measure fecal calprotectin. Given that this was a multicenter study, please clarify whether a
uniformed approach used to measure fecal calprotectin levels? At what timepoint were CRP and
fecal calprotectin measured?
Results
#Table 1 should also show fecal calprotectin and CRP values for the assessment of UC activity
in all cases. Please provide the clinical activity index if the data are available.
# Multiple colonoscopies have been performed in a single patient. What is the maximum number
of colonoscopies that were performed in a patient?
#In Table 4, what do 0 and 1 in topical 5-ASA represent?
#The MES and UCEIS of 7.6% and 8.6%, respectively, were more severe in the proximal
colon area than in the rectosigmoid colon area. In these cases, however, performing multiple
colonoscopies in the same patient will have a significant influence on the results. Out of the
percentages provided, how many colonoscopy findings were from the same patient?
#It was stated that "as an endoscopic evaluation for disease activity in patients with ulcerative
colitis, MES #2 or UCEIS #5 is evaluated as active disease, and escalation of drugs should be
considered" (Page 7, Line 159). The reference or basis for these endoscopic cutoff values should
be provided in the Methods section.
# Table 4 presents a comparison of cases in which sigmoidoscopy and colonoscopy can be
evaluated. This table presents an important comparison for exploring the factors that require
colonoscopy in this study; it was pointed out that disease extent is an important criterion to
consider, which is also realized in clinical practice. However, this notion is extremely simplistic,
and more criteria should be analyzed to accurately determine which specific factors result in the
need for colonoscopy. Please show the results of other factors such as sex, age, and duration
of illness.
Minor Comments
#The notation in Table 1 should be modified as follows: Male (n, %) # Male, n (%)
#It should be explained what the median age and disease duration of Table 1 are ± 17.78 and
± 48.88, respectively.
#Please indicate the units of CRP and fecal calprotectin in Table 4.
Please review this paper.
user
Title: Efficacy of Sigmoidoscopy for Evaluating Disease Activity in Patients with Ulcerative
Colitis
Version: 2 Date: 07 Dec 2021
Reviewer's report:
I am very pleased to have been given the opportunity to review this study.
Assessing mucosal status via colonoscopy for the evaluation of disease activity in patients with
ulcerative colitis (UC) is important in guiding treatment decisions, but it is often difficult to
perform total colonoscopy. While this study managed to discuss the evaluation of activity in UC
using colonoscopy, it requires the following considerations and revisions.
Major Comments
Background
#MES stands for Mayo Endoscopic Subscore, not Mayo Endoscopic Score. Please ensure that
this abbreviation is corrected in the main text, abstract, tables, and figures.
Methods
# CRP and fecal calprotectin were evaluated in this study, but there are several methods to
measure fecal calprotectin. Given that this was a multicenter study, please clarify whether a
uniformed approach used to measure fecal calprotectin levels? At what timepoint were CRP and
fecal calprotectin measured?
Results
#Table 1 should also show fecal calprotectin and CRP values for the assessment of UC activity
in all cases. Please provide the clinical activity index if the data are available.
# Multiple colonoscopies have been performed in a single patient. What is the maximum number
of colonoscopies that were performed in a patient?
#In Table 4, what do 0 and 1 in topical 5-ASA represent?
#The MES and UCEIS of 7.6% and 8.6%, respectively, were more severe in the proximal
colon area than in the rectosigmoid colon area. In these cases, however, performing multiple
colonoscopies in the same patient will have a significant influence on the results. Out of the
percentages provided, how many colonoscopy findings were from the same patient?
#It was stated that "as an endoscopic evaluation for disease activity in patients with ulcerative
colitis, MES #2 or UCEIS #5 is evaluated as active disease, and escalation of drugs should be
considered" (Page 7, Line 159). The reference or basis for these endoscopic cutoff values should
be provided in the Methods section.
# Table 4 presents a comparison of cases in which sigmoidoscopy and colonoscopy can be
evaluated. This table presents an important comparison for exploring the factors that require
colonoscopy in this study; it was pointed out that disease extent is an important criterion to
consider, which is also realized in clinical practice. However, this notion is extremely simplistic,
and more criteria should be analyzed to accurately determine which specific factors result in the
need for colonoscopy. Please show the results of other factors such as sex, age, and duration
of illness.
Minor Comments
#The notation in Table 1 should be modified as follows: Male (n, %) # Male, n (%)
#It should be explained what the median age and disease duration of Table 1 are ± 17.78 and
± 48.88, respectively.
#Please indicate the units of CRP and fecal calprotectin in Table 4.
assistant