Reviewer's report
Title:Diagnostic yield of endoscopy in patients with abdominal complaints:
Incremental value of fecal calprotectin on guidelines of appropriateness
Version:1Date:16 November 2013
Reviewer: Antonio Tursi
Reviewer's report:
This interesting study assessed the role of fecal calprotectin (FC) in increasing
the diagnostic yield of colonoscopy using EPAGE criteria. Autors found that the
addition of FC to EPAGE criteria improved the risk reclassification of patients by
endoscopic findings. Thus, diagnostic yield improved to 56.8% and to 70.2% for
EGDscopy and colonoscopy respectively.
Although limited by the retrospective design, this study is very interesting for
clinical setting, because is assesses how to improve the diagnostic yield of
EPAGE criteria. Using FC as supplementary test may be an interesting option to
reach this result. However, three major points need to be addressed.
1. Authors did not find alarm symptoms as effective predictors of significant
findings. This denies the EPAGE criteria, and needs to be adequately discussed.
2. Authors found that the 58µg/g cut-off is the cut-off which has significant
probability to find lesions at EGDscopy. This is a surprising finding, because FC
wasn’t find increased both in chronic gastritis (Montalto M et al. WJG 2010;16:
3406-10) and in celiac disease (Montalto M et al. Scand J Gastroenterol 2007;42:
957-61). These studies should be cited and commented, as well as authors
should provide some explanation of their results.
3. Adding FC increases diagnostic costs. This is particularly true for ELISA tests,
which require higher costs than semi-quantitative tests. Authors should therefore
provide an analysis of increased costs in adding FC to diagnostic work-up, and
comment the results.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Diagnostic yield of endoscopy in patients with abdominal complaints:
Incremental value of fecal calprotectin on guidelines of appropriateness
Version:1Date:16 November 2013
Reviewer: Antonio Tursi
Reviewer's report:
This interesting study assessed the role of fecal calprotectin (FC) in increasing
the diagnostic yield of colonoscopy using EPAGE criteria. Autors found that the
addition of FC to EPAGE criteria improved the risk reclassification of patients by
endoscopic findings. Thus, diagnostic yield improved to 56.8% and to 70.2% for
EGDscopy and colonoscopy respectively.
Although limited by the retrospective design, this study is very interesting for
clinical setting, because is assesses how to improve the diagnostic yield of
EPAGE criteria. Using FC as supplementary test may be an interesting option to
reach this result. However, three major points need to be addressed.
1. Authors did not find alarm symptoms as effective predictors of significant
findings. This denies the EPAGE criteria, and needs to be adequately discussed.
2. Authors found that the 58µg/g cut-off is the cut-off which has significant
probability to find lesions at EGDscopy. This is a surprising finding, because FC
wasn’t find increased both in chronic gastritis (Montalto M et al. WJG 2010;16:
3406-10) and in celiac disease (Montalto M et al. Scand J Gastroenterol 2007;42:
957-61). These studies should be cited and commented, as well as authors
should provide some explanation of their results.
3. Adding FC increases diagnostic costs. This is particularly true for ELISA tests,
which require higher costs than semi-quantitative tests. Authors should therefore
provide an analysis of increased costs in adding FC to diagnostic work-up, and
comment the results.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Diagnostic yield of endoscopy in patients with abdominal complaints:
Incremental value of fecal calprotectin on guidelines of appropriateness
Version:1Date:16 November 2013
Reviewer: Antonio Tursi
Reviewer's report:
This interesting study assessed the role of fecal calprotectin (FC) in increasing
the diagnostic yield of colonoscopy using EPAGE criteria. Autors found that the
addition of FC to EPAGE criteria improved the risk reclassification of patients by
endoscopic findings. Thus, diagnostic yield improved to 56.8% and to 70.2% for
EGDscopy and colonoscopy respectively.
Although limited by the retrospective design, this study is very interesting for
clinical setting, because is assesses how to improve the diagnostic yield of
EPAGE criteria. Using FC as supplementary test may be an interesting option to
reach this result. However, three major points need to be addressed.
1. Authors did not find alarm symptoms as effective predictors of significant
findings. This denies the EPAGE criteria, and needs to be adequately discussed.
2. Authors found that the 58µg/g cut-off is the cut-off which has significant
probability to find lesions at EGDscopy. This is a surprising finding, because FC
wasn’t find increased both in chronic gastritis (Montalto M et al. WJG 2010;16:
3406-10) and in celiac disease (Montalto M et al. Scand J Gastroenterol 2007;42:
957-61). These studies should be cited and commented, as well as authors
should provide some explanation of their results.
3. Adding FC increases diagnostic costs. This is particularly true for ELISA tests,
which require higher costs than semi-quantitative tests. Authors should therefore
provide an analysis of increased costs in adding FC to diagnostic work-up, and
comment the results.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.
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