Title: Total polyp number may be more important than size and histology of polyps for
prediction of metachronous high-risk colorectal neoplasms
Version: 2 Date: 23 Jan 2022
Reviewer's report:
Comments to the Author
This manuscript evaluates which factors best predict the risk of metachronous high-risk
colorectal neoplasms. Currently, intervals between colonoscopies are based on the size, number
and histopathology of retrieved polyps. However, risk stratification is not precise enough due
to a lack of strong evidence.
The manuscript has some drawbacks especially in his methodology.
A one-year follow-up colonoscopy in the population group defined as high risk according to the
different follow-up guidelines aims to ensure a complete resection of neoplasms (missed polyps
and incomplete resection of large polyps) before starting surveillance. Above all, I believe that in
order to draw robust conclusions about which are the variables that most influence the indication
for surveillance colonoscopy at one year, a prospective and ideally randomized study should be
carried out (comparing the results at 3 years in two cohorts: 1) cohort with review colonoscopy
at 1 year and surveillance at 3 years 2) cohort with colonoscopy at 3 years)), which would avoid
excluding patients.
Where exactly the included individuals come from: CRC population screening program?
colonoscopies performed for another reason?
To guarantee the homogeneity of the sample, it should be described if baseline colonoscopies
were performed following an identical protocol of quality standards. In addition, the fact of not
knowing if the index colonoscopy was the first one or if others had already been performed does
not guarantee the homogeneity of the sample either.
Patients with sessile serrated lesions (serrated polyps # 10 mm or with dysplasia including
traditional sessile adenomas) that appear to be associated with an increased risk of neoplasms or
metachronous CRC should be offered a surveillance colonoscopic examination at 3 years (East
JE Gut 2017). The authors should address that serrated polyps with dysplasia are also considered
high-risk lesions.
No mention is made to the morphological characteristics (Paris) of the resected lesions, which
is especially important in large lesions (# 20 mm).
The exclusion of patients with colonoscopy less than 12 months after index colonoscopy to rule
out patients with probable missed lesions is somewhat doubtful. It would be desirable that the
reason for performing it before a year be detailed: to ensure a complete resection of large polyps?
poor preparation? incomplete colonoscopies?
It would be interesting to know if the quality of the colonoscopy was appropriate (and not only
if the endoscopists were experts), as well as an estimate of the subsequent polyps’miss rate.
The patient inclusion period should be in Methodology and not in Results.
The conclusions should be taken with caution because it is a retrospective single-center study.
As mentioned, more precise methodology and a larger number of cases included in the study
could have helped to obtain more relevant results.
Title: Total polyp number may be more important than size and histology of polyps for
prediction of metachronous high-risk colorectal neoplasms
Version: 2 Date: 23 Jan 2022
Reviewer's report:
Comments to the Author
This manuscript evaluates which factors best predict the risk of metachronous high-risk
colorectal neoplasms. Currently, intervals between colonoscopies are based on the size, number
and histopathology of retrieved polyps. However, risk stratification is not precise enough due
to a lack of strong evidence.
The manuscript has some drawbacks especially in his methodology.
A one-year follow-up colonoscopy in the population group defined as high risk according to the
different follow-up guidelines aims to ensure a complete resection of neoplasms (missed polyps
and incomplete resection of large polyps) before starting surveillance. Above all, I believe that in
order to draw robust conclusions about which are the variables that most influence the indication
for surveillance colonoscopy at one year, a prospective and ideally randomized study should be
carried out (comparing the results at 3 years in two cohorts: 1) cohort with review colonoscopy
at 1 year and surveillance at 3 years 2) cohort with colonoscopy at 3 years)), which would avoid
excluding patients.
Where exactly the included individuals come from: CRC population screening program?
colonoscopies performed for another reason?
To guarantee the homogeneity of the sample, it should be described if baseline colonoscopies
were performed following an identical protocol of quality standards. In addition, the fact of not
knowing if the index colonoscopy was the first one or if others had already been performed does
not guarantee the homogeneity of the sample either.
Patients with sessile serrated lesions (serrated polyps # 10 mm or with dysplasia including
traditional sessile adenomas) that appear to be associated with an increased risk of neoplasms or
metachronous CRC should be offered a surveillance colonoscopic examination at 3 years (East
JE Gut 2017). The authors should address that serrated polyps with dysplasia are also considered
high-risk lesions.
No mention is made to the morphological characteristics (Paris) of the resected lesions, which
is especially important in large lesions (# 20 mm).
The exclusion of patients with colonoscopy less than 12 months after index colonoscopy to rule
out patients with probable missed lesions is somewhat doubtful. It would be desirable that the
reason for performing it before a year be detailed: to ensure a complete resection of large polyps?
poor preparation? incomplete colonoscopies?
It would be interesting to know if the quality of the colonoscopy was appropriate (and not only
if the endoscopists were experts), as well as an estimate of the subsequent polyps’miss rate.
The patient inclusion period should be in Methodology and not in Results.
The conclusions should be taken with caution because it is a retrospective single-center study.
As mentioned, more precise methodology and a larger number of cases included in the study
could have helped to obtain more relevant results.
Please review this paper.
user
Title: Total polyp number may be more important than size and histology of polyps for
prediction of metachronous high-risk colorectal neoplasms
Version: 2 Date: 23 Jan 2022
Reviewer's report:
Comments to the Author
This manuscript evaluates which factors best predict the risk of metachronous high-risk
colorectal neoplasms. Currently, intervals between colonoscopies are based on the size, number
and histopathology of retrieved polyps. However, risk stratification is not precise enough due
to a lack of strong evidence.
The manuscript has some drawbacks especially in his methodology.
A one-year follow-up colonoscopy in the population group defined as high risk according to the
different follow-up guidelines aims to ensure a complete resection of neoplasms (missed polyps
and incomplete resection of large polyps) before starting surveillance. Above all, I believe that in
order to draw robust conclusions about which are the variables that most influence the indication
for surveillance colonoscopy at one year, a prospective and ideally randomized study should be
carried out (comparing the results at 3 years in two cohorts: 1) cohort with review colonoscopy
at 1 year and surveillance at 3 years 2) cohort with colonoscopy at 3 years)), which would avoid
excluding patients.
Where exactly the included individuals come from: CRC population screening program?
colonoscopies performed for another reason?
To guarantee the homogeneity of the sample, it should be described if baseline colonoscopies
were performed following an identical protocol of quality standards. In addition, the fact of not
knowing if the index colonoscopy was the first one or if others had already been performed does
not guarantee the homogeneity of the sample either.
Patients with sessile serrated lesions (serrated polyps # 10 mm or with dysplasia including
traditional sessile adenomas) that appear to be associated with an increased risk of neoplasms or
metachronous CRC should be offered a surveillance colonoscopic examination at 3 years (East
JE Gut 2017). The authors should address that serrated polyps with dysplasia are also considered
high-risk lesions.
No mention is made to the morphological characteristics (Paris) of the resected lesions, which
is especially important in large lesions (# 20 mm).
The exclusion of patients with colonoscopy less than 12 months after index colonoscopy to rule
out patients with probable missed lesions is somewhat doubtful. It would be desirable that the
reason for performing it before a year be detailed: to ensure a complete resection of large polyps?
poor preparation? incomplete colonoscopies?
It would be interesting to know if the quality of the colonoscopy was appropriate (and not only
if the endoscopists were experts), as well as an estimate of the subsequent polyps’miss rate.
The patient inclusion period should be in Methodology and not in Results.
The conclusions should be taken with caution because it is a retrospective single-center study.
As mentioned, more precise methodology and a larger number of cases included in the study
could have helped to obtain more relevant results.
assistant