Reviewer's report
Title:The increasing role of endoscopy in the management of intestinal
obstruction: a 20-year retrospective study
Version: 1Date:18 May 2010
Reviewer: David I Watson
Reviewer's report:
This study claims to evaluate the role of endoscopy in the management of
intestinal obstruction, and concludes that it is becoming increasingly important.
The data presented does not support this conclusion.
The authors have really only evaluated colonoscopy in suspected large bowel
obstruction. The title and the use of words throughout the paper should be
changed to reflect this reality.
Colonoscopy should replace endoscopy throughout the paper. Endoscopy
implies gastroscopy in the English language literature – the paper did not
consider gastroscopy.
The authors have inflated the apparent importance of their data set by
emphasising how many surgical and colonoscopy records they evaluated. This is
a retrospective study of 655 patients indentified from colonoscopy and surgical
records. The 26,000 and 18,000 denominators used inflate the apparent value of
the data set.
A proper review of management of bowel obstruction would start with hospital
diagnosis at discharge. The authors’ case selection has excluded all the patients
who did not undergo surgery or colonoscopy. This means that their interpretaton
of the importance of their data is limited by an incomplete data set – ie it would
be expect that there would be another missing 20,000 to 30,000 patients who
presented with bowel obstruction, but did not require intervention over the same
time frame. By not including these patients, and by using a retrospective case
note review methodology, the authors cannot really show that they have helped
anyone by undertaking colonoscopy. What would have happened if they didn’t do
colonoscopy? What were the complications associated with undertaking
colonoscopy? Were there any downsides? Using colonoscopy, does not prove
that it is useful. For all we know it could have been harmful?
There is little detail provided about the surgical interventions.
I don’t think the paper has really looked at the question of small bowel
obstruction at all, and this should be acknowledged clearly.
The %values in tables 1 and 3 should be reversed – ie calculate denominators
across rows in table 1, not columns, and in tabled 3, calculate the % down the
rows.
Table 2 shows that only 20/203 patients undergoing colonoscopy have had a
therapeutic intervention, and the paper does not provide any information about
whether this was successful or not. More than 90% had a colonoscopy which
was not therapeutic. This is less than 3% of the overall study group, and might be
only 1-2% of all patients presenting with bowel obstruction to the hospital (if the
patients not having an intervention are included). This means that colonoscopy
has a more limited and less useful role than the paper claims.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Reviewer's report
Title:The increasing role of endoscopy in the management of intestinal
obstruction: a 20-year retrospective study
Version: 1Date:18 May 2010
Reviewer: David I Watson
Reviewer's report:
This study claims to evaluate the role of endoscopy in the management of
intestinal obstruction, and concludes that it is becoming increasingly important.
The data presented does not support this conclusion.
The authors have really only evaluated colonoscopy in suspected large bowel
obstruction. The title and the use of words throughout the paper should be
changed to reflect this reality.
Colonoscopy should replace endoscopy throughout the paper. Endoscopy
implies gastroscopy in the English language literature – the paper did not
consider gastroscopy.
The authors have inflated the apparent importance of their data set by
emphasising how many surgical and colonoscopy records they evaluated. This is
a retrospective study of 655 patients indentified from colonoscopy and surgical
records. The 26,000 and 18,000 denominators used inflate the apparent value of
the data set.
A proper review of management of bowel obstruction would start with hospital
diagnosis at discharge. The authors’ case selection has excluded all the patients
who did not undergo surgery or colonoscopy. This means that their interpretaton
of the importance of their data is limited by an incomplete data set – ie it would
be expect that there would be another missing 20,000 to 30,000 patients who
presented with bowel obstruction, but did not require intervention over the same
time frame. By not including these patients, and by using a retrospective case
note review methodology, the authors cannot really show that they have helped
anyone by undertaking colonoscopy. What would have happened if they didn’t do
colonoscopy? What were the complications associated with undertaking
colonoscopy? Were there any downsides? Using colonoscopy, does not prove
that it is useful. For all we know it could have been harmful?
There is little detail provided about the surgical interventions.
I don’t think the paper has really looked at the question of small bowel
obstruction at all, and this should be acknowledged clearly.
The %values in tables 1 and 3 should be reversed – ie calculate denominators
across rows in table 1, not columns, and in tabled 3, calculate the % down the
rows.
Table 2 shows that only 20/203 patients undergoing colonoscopy have had a
therapeutic intervention, and the paper does not provide any information about
whether this was successful or not. More than 90% had a colonoscopy which
was not therapeutic. This is less than 3% of the overall study group, and might be
only 1-2% of all patients presenting with bowel obstruction to the hospital (if the
patients not having an intervention are included). This means that colonoscopy
has a more limited and less useful role than the paper claims.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Please review this paper.
user
Reviewer's report
Title:The increasing role of endoscopy in the management of intestinal
obstruction: a 20-year retrospective study
Version: 1Date:18 May 2010
Reviewer: David I Watson
Reviewer's report:
This study claims to evaluate the role of endoscopy in the management of
intestinal obstruction, and concludes that it is becoming increasingly important.
The data presented does not support this conclusion.
The authors have really only evaluated colonoscopy in suspected large bowel
obstruction. The title and the use of words throughout the paper should be
changed to reflect this reality.
Colonoscopy should replace endoscopy throughout the paper. Endoscopy
implies gastroscopy in the English language literature – the paper did not
consider gastroscopy.
The authors have inflated the apparent importance of their data set by
emphasising how many surgical and colonoscopy records they evaluated. This is
a retrospective study of 655 patients indentified from colonoscopy and surgical
records. The 26,000 and 18,000 denominators used inflate the apparent value of
the data set.
A proper review of management of bowel obstruction would start with hospital
diagnosis at discharge. The authors’ case selection has excluded all the patients
who did not undergo surgery or colonoscopy. This means that their interpretaton
of the importance of their data is limited by an incomplete data set – ie it would
be expect that there would be another missing 20,000 to 30,000 patients who
presented with bowel obstruction, but did not require intervention over the same
time frame. By not including these patients, and by using a retrospective case
note review methodology, the authors cannot really show that they have helped
anyone by undertaking colonoscopy. What would have happened if they didn’t do
colonoscopy? What were the complications associated with undertaking
colonoscopy? Were there any downsides? Using colonoscopy, does not prove
that it is useful. For all we know it could have been harmful?
There is little detail provided about the surgical interventions.
I don’t think the paper has really looked at the question of small bowel
obstruction at all, and this should be acknowledged clearly.
The %values in tables 1 and 3 should be reversed – ie calculate denominators
across rows in table 1, not columns, and in tabled 3, calculate the % down the
rows.
Table 2 shows that only 20/203 patients undergoing colonoscopy have had a
therapeutic intervention, and the paper does not provide any information about
whether this was successful or not. More than 90% had a colonoscopy which
was not therapeutic. This is less than 3% of the overall study group, and might be
only 1-2% of all patients presenting with bowel obstruction to the hospital (if the
patients not having an intervention are included). This means that colonoscopy
has a more limited and less useful role than the paper claims.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
assistant