Reviewer’s report
Title:  The influence of various distractions prior to upper gastrointestinal endoscopy: A Prospective
Randomized Controlled Study
Version: 1 Date: 03 May 2018
Reviewer: Rita Busuttil
Reviewer's report:
Sogabe et al have sought to determine the effect of pre-endoscopic distractions on patient anxiety using
subjective and objective assessments.  Although well described, the authors have not commented on the
feasibility of implementing such strategies and whether the patient benefit would justify this.
1)The manuscript should be reviewed by a fluent English speaker to help with grammar
issues and flow of the manuscript
2)Why was only 10 minutes of distraction used? Given that patients may be sitting in the
clinic for a long period before being seen I suspect that a longer period of distraction may be
extra beneficial.
3)Abstract- Results Page 4 line 55. "There was no significant difference in vital signs
between pre- and post- distraction in group 1". If the control group has no distraction how can
there  be  a  pre-  and  post-  distraction  measurement?  Do  the  authors  mean  pre  and  post
endoscopy?
4)Table 2-Based on the fact the allocation to groups was random and given that some of
the patients had up to 20 endoscopic procedures how were these accounted for the distribution
into groups? Can the authors show the ranges for this data (Age and Number of examinations)?
5)The authors don't refer to specific panels within their figures. This would make it easier
to read.
6)The authors have not compared baseline vital sign values between the 4 groups. Can the
authors discuss why group 3 may have had a lower baseline level reading for SBP and DBP
than the other groups? This is in fact lower or comparable to the post distraction readings for the
other groups.
7)Although patients were randomly allocated into groups they would have been aware of
the purpose of the study (based on the consent forms). This makes me wonder whether the self-
reported results may have been unintentionally biased. Can the authors comment on this?
8)Given that the patients enrolled in this study are "healthy" there would only be anxiety
related to the procedure that may be reduced by the distraction. This however may not be the
same in "unwell patients" who may have the added burden of an unpleasant diagnosis. It would
be interesting to determine whether distractions are effective in these cases. This point was
acknowledged by the authors.
9)It would have been interesting for the authors to have measured all of the physical
factors post endoscopy to determine whether pre-endoscopic distraction had any effect on the
patient afterwards.
10)Can the authors comment on the costs and feasibility associated with implementing such
a strategy in everyday clinic? Does the benefit observed justify this?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional 
statistical review?
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose financially 
from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds or 
has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If 
your reply is yes to any, please give details below.
I declare that I have no competing interests
I agree to the open peer review policy of the journal. I understand that my name will be includedon my 
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal
Reviewer’s report
Title:  The influence of various distractions prior to upper gastrointestinal endoscopy: A Prospective
Randomized Controlled Study
Version: 1 Date: 03 May 2018
Reviewer: Rita Busuttil
Reviewer's report:
Sogabe et al have sought to determine the effect of pre-endoscopic distractions on patient anxiety using
subjective and objective assessments.  Although well described, the authors have not commented on the
feasibility of implementing such strategies and whether the patient benefit would justify this.
1)The manuscript should be reviewed by a fluent English speaker to help with grammar
issues and flow of the manuscript
2)Why was only 10 minutes of distraction used? Given that patients may be sitting in the
clinic for a long period before being seen I suspect that a longer period of distraction may be
extra beneficial.
3)Abstract- Results Page 4 line 55. "There was no significant difference in vital signs
between pre- and post- distraction in group 1". If the control group has no distraction how can
there  be  a  pre-  and  post-  distraction  measurement?  Do  the  authors  mean  pre  and  post
endoscopy?
4)Table 2-Based on the fact the allocation to groups was random and given that some of
the patients had up to 20 endoscopic procedures how were these accounted for the distribution
into groups? Can the authors show the ranges for this data (Age and Number of examinations)?
5)The authors don't refer to specific panels within their figures. This would make it easier
to read.
6)The authors have not compared baseline vital sign values between the 4 groups. Can the
authors discuss why group 3 may have had a lower baseline level reading for SBP and DBP
than the other groups? This is in fact lower or comparable to the post distraction readings for the
other groups.
7)Although patients were randomly allocated into groups they would have been aware of
the purpose of the study (based on the consent forms). This makes me wonder whether the self-
reported results may have been unintentionally biased. Can the authors comment on this?
8)Given that the patients enrolled in this study are "healthy" there would only be anxiety
related to the procedure that may be reduced by the distraction. This however may not be the
same in "unwell patients" who may have the added burden of an unpleasant diagnosis. It would
be interesting to determine whether distractions are effective in these cases. This point was
acknowledged by the authors.
9)It would have been interesting for the authors to have measured all of the physical
factors post endoscopy to determine whether pre-endoscopic distraction had any effect on the
patient afterwards.
10)Can the authors comment on the costs and feasibility associated with implementing such
a strategy in everyday clinic? Does the benefit observed justify this?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional 
statistical review?
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose financially 
from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds or 
has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If 
your reply is yes to any, please give details below.
I declare that I have no competing interests
I agree to the open peer review policy of the journal. I understand that my name will be includedon my 
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal
Please review this paper.
user
Reviewer’s report
Title:  The influence of various distractions prior to upper gastrointestinal endoscopy: A Prospective
Randomized Controlled Study
Version: 1 Date: 03 May 2018
Reviewer: Rita Busuttil
Reviewer's report:
Sogabe et al have sought to determine the effect of pre-endoscopic distractions on patient anxiety using
subjective and objective assessments.  Although well described, the authors have not commented on the
feasibility of implementing such strategies and whether the patient benefit would justify this.
1)The manuscript should be reviewed by a fluent English speaker to help with grammar
issues and flow of the manuscript
2)Why was only 10 minutes of distraction used? Given that patients may be sitting in the
clinic for a long period before being seen I suspect that a longer period of distraction may be
extra beneficial.
3)Abstract- Results Page 4 line 55. "There was no significant difference in vital signs
between pre- and post- distraction in group 1". If the control group has no distraction how can
there  be  a  pre-  and  post-  distraction  measurement?  Do  the  authors  mean  pre  and  post
endoscopy?
4)Table 2-Based on the fact the allocation to groups was random and given that some of
the patients had up to 20 endoscopic procedures how were these accounted for the distribution
into groups? Can the authors show the ranges for this data (Age and Number of examinations)?
5)The authors don't refer to specific panels within their figures. This would make it easier
to read.
6)The authors have not compared baseline vital sign values between the 4 groups. Can the
authors discuss why group 3 may have had a lower baseline level reading for SBP and DBP
than the other groups? This is in fact lower or comparable to the post distraction readings for the
other groups.
7)Although patients were randomly allocated into groups they would have been aware of
the purpose of the study (based on the consent forms). This makes me wonder whether the self-
reported results may have been unintentionally biased. Can the authors comment on this?
8)Given that the patients enrolled in this study are "healthy" there would only be anxiety
related to the procedure that may be reduced by the distraction. This however may not be the
same in "unwell patients" who may have the added burden of an unpleasant diagnosis. It would
be interesting to determine whether distractions are effective in these cases. This point was
acknowledged by the authors.
9)It would have been interesting for the authors to have measured all of the physical
factors post endoscopy to determine whether pre-endoscopic distraction had any effect on the
patient afterwards.
10)Can the authors comment on the costs and feasibility associated with implementing such
a strategy in everyday clinic? Does the benefit observed justify this?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional 
statistical review?
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose financially 
from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds or 
has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If 
your reply is yes to any, please give details below.
I declare that I have no competing interests
I agree to the open peer review policy of the journal. I understand that my name will be includedon my 
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal
assistant