Title: Appropriateness of Colonoscopies in a Tunisian Endoscopy Center: Factors and EPAGE-
I/II Criteria Comparison
Version: 4 Date: 30 May 2024
Reviewer:  Rui Sousa Magalhães
Reviewer's report:
Comments to authors:
I read with much interest the original article presented, focusing in a study analysing criteria for
appropriateness of colonoscopies and the comparison between EPAGE-I and EPAGE-II. The
study comprises a single-center cross-sectional analysis. The primary outcome was to assess the
rate of appropriateness of colonoscopies at the specific center.
Major points:
- If possible, the key words would benefit to be changed according to MESH terms.
- In an advisory note I would recommend to shorten the title
Methods:
- Despite providing a link to the EPAGE criteria, the manuscript would benefit from a brief
explanation on how the score works, for instance, regarding the values attributed to each
criterion. Can the authors provide one?
- Regarding the sentence, “The following endoscopic findings were categorized as relevant:…
microscopic colitis, infectious colitis and eosinophilic colitis.” Can the authors specify what
endoscopic findings they used to diagnose these three entities?
Results
- From 1972 colonoscopies 361 were deemed incomplete. This is a rather high number. Can the
authors provide any reasoning?
- The authors refer to 283 colonoscopies with bad preparation, this seems rather high. What is
the protocol implemented?
- The authors refer to 157 colonoscopies with bad tolerance, are all colonoscopies performed
under no sedation?
- Regarding the sentence, “Screening colonoscopies in asymptomatic patients or with known
IBD represented 4.5% of the overall indications” How is the screening protocol implemented
in your hospital?
- “The agreement between EPAGE I and EPAGE II criteria was slight using the weighted version
of k (k= 0.153)” EPAGE I and II have several criteria and criterion combination. Can the authors
comment on how this factor can difficult the k analysis? And how to overcome it?
- The diagnostic yeld of 8.5 for angiodysplasia and 9.8 for IBD is rather high, can the authors
comment on this?
Discussion
- The discussion is extensive and would benefit to be shortened.
- Post polypectomy surveillance has specific guidelines. Can the authors comment on the benefit
of applying EPAGE II criteria?
- Regarding the criterion uncomplicated diarrhoea, can the authors provide information on how
long the symptom needs to be affecting the patient for it to be considered positive?
- Haematochezia is a criterion for colonoscopy. Can the authors comment on this. And how the
EPAGE criteria interfer with this statement?
- The reference 28 is from 2009, there are recent guidelines regarding post polypectomy
surveillance, does the EPAGE II has this into account?
- Regarding the sentence from the introduction section: “Due to limited resources, we critically
reviewed our clinical practice in order to help propose efficient strategies to control the growing
demand in our endoscopy unit.” What measures do the authors propose?
Title: Appropriateness of Colonoscopies in a Tunisian Endoscopy Center: Factors and EPAGE-
I/II Criteria Comparison
Version: 4 Date: 30 May 2024
Reviewer:  Rui Sousa Magalhães
Reviewer's report:
Comments to authors:
I read with much interest the original article presented, focusing in a study analysing criteria for
appropriateness of colonoscopies and the comparison between EPAGE-I and EPAGE-II. The
study comprises a single-center cross-sectional analysis. The primary outcome was to assess the
rate of appropriateness of colonoscopies at the specific center.
Major points:
- If possible, the key words would benefit to be changed according to MESH terms.
- In an advisory note I would recommend to shorten the title
Methods:
- Despite providing a link to the EPAGE criteria, the manuscript would benefit from a brief
explanation on how the score works, for instance, regarding the values attributed to each
criterion. Can the authors provide one?
- Regarding the sentence, “The following endoscopic findings were categorized as relevant:…
microscopic colitis, infectious colitis and eosinophilic colitis.” Can the authors specify what
endoscopic findings they used to diagnose these three entities?
Results
- From 1972 colonoscopies 361 were deemed incomplete. This is a rather high number. Can the
authors provide any reasoning?
- The authors refer to 283 colonoscopies with bad preparation, this seems rather high. What is
the protocol implemented?
- The authors refer to 157 colonoscopies with bad tolerance, are all colonoscopies performed
under no sedation?
- Regarding the sentence, “Screening colonoscopies in asymptomatic patients or with known
IBD represented 4.5% of the overall indications” How is the screening protocol implemented
in your hospital?
- “The agreement between EPAGE I and EPAGE II criteria was slight using the weighted version
of k (k= 0.153)” EPAGE I and II have several criteria and criterion combination. Can the authors
comment on how this factor can difficult the k analysis? And how to overcome it?
- The diagnostic yeld of 8.5 for angiodysplasia and 9.8 for IBD is rather high, can the authors
comment on this?
Discussion
- The discussion is extensive and would benefit to be shortened.
- Post polypectomy surveillance has specific guidelines. Can the authors comment on the benefit
of applying EPAGE II criteria?
- Regarding the criterion uncomplicated diarrhoea, can the authors provide information on how
long the symptom needs to be affecting the patient for it to be considered positive?
- Haematochezia is a criterion for colonoscopy. Can the authors comment on this. And how the
EPAGE criteria interfer with this statement?
- The reference 28 is from 2009, there are recent guidelines regarding post polypectomy
surveillance, does the EPAGE II has this into account?
- Regarding the sentence from the introduction section: “Due to limited resources, we critically
reviewed our clinical practice in order to help propose efficient strategies to control the growing
demand in our endoscopy unit.” What measures do the authors propose?
Please review this paper.
user
Title: Appropriateness of Colonoscopies in a Tunisian Endoscopy Center: Factors and EPAGE-
I/II Criteria Comparison
Version: 4 Date: 30 May 2024
Reviewer:  Rui Sousa Magalhães
Reviewer's report:
Comments to authors:
I read with much interest the original article presented, focusing in a study analysing criteria for
appropriateness of colonoscopies and the comparison between EPAGE-I and EPAGE-II. The
study comprises a single-center cross-sectional analysis. The primary outcome was to assess the
rate of appropriateness of colonoscopies at the specific center.
Major points:
- If possible, the key words would benefit to be changed according to MESH terms.
- In an advisory note I would recommend to shorten the title
Methods:
- Despite providing a link to the EPAGE criteria, the manuscript would benefit from a brief
explanation on how the score works, for instance, regarding the values attributed to each
criterion. Can the authors provide one?
- Regarding the sentence, “The following endoscopic findings were categorized as relevant:…
microscopic colitis, infectious colitis and eosinophilic colitis.” Can the authors specify what
endoscopic findings they used to diagnose these three entities?
Results
- From 1972 colonoscopies 361 were deemed incomplete. This is a rather high number. Can the
authors provide any reasoning?
- The authors refer to 283 colonoscopies with bad preparation, this seems rather high. What is
the protocol implemented?
- The authors refer to 157 colonoscopies with bad tolerance, are all colonoscopies performed
under no sedation?
- Regarding the sentence, “Screening colonoscopies in asymptomatic patients or with known
IBD represented 4.5% of the overall indications” How is the screening protocol implemented
in your hospital?
- “The agreement between EPAGE I and EPAGE II criteria was slight using the weighted version
of k (k= 0.153)” EPAGE I and II have several criteria and criterion combination. Can the authors
comment on how this factor can difficult the k analysis? And how to overcome it?
- The diagnostic yeld of 8.5 for angiodysplasia and 9.8 for IBD is rather high, can the authors
comment on this?
Discussion
- The discussion is extensive and would benefit to be shortened.
- Post polypectomy surveillance has specific guidelines. Can the authors comment on the benefit
of applying EPAGE II criteria?
- Regarding the criterion uncomplicated diarrhoea, can the authors provide information on how
long the symptom needs to be affecting the patient for it to be considered positive?
- Haematochezia is a criterion for colonoscopy. Can the authors comment on this. And how the
EPAGE criteria interfer with this statement?
- The reference 28 is from 2009, there are recent guidelines regarding post polypectomy
surveillance, does the EPAGE II has this into account?
- Regarding the sentence from the introduction section: “Due to limited resources, we critically
reviewed our clinical practice in order to help propose efficient strategies to control the growing
demand in our endoscopy unit.” What measures do the authors propose?
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