Title: Positioning exercises in improving the quality of Magnetic-controlled Capsule Endoscopy
Version: 1 Date: 09 Jul 2024
Reviewer's report:
The study is of interest and I agree with the authors that techniques to improve gastric preparation
which involve standing exercises such as those described are likely to be easier for patients to
comply with than distributing the intragastric water and simethicone by repeated rotations from
the supine to prone positions, which some find difficult.
It is not entirely clear, but as the document describes this as a retrospective study, I assume that
the two groups compared are historical cohorts in which the cmp-Group followed the original
protocol (n=159) which was changed at some point (to a pe protocol) following which all
followed the new protocol. (n= 148).
The pe protocol results in better cleanliness and mucosal visualisation compared  to the cmp
protocol. However, some of the claims are overstated because there are limitations to the study
which are not discussed and therefore, unwarranted conclusions are drawn:
1. The authors state that 'positioning exercises facilitated the distribution of defoaming and
mucolytic agents to more areas within the gastric cavity.' This might be inferred as the pe group
had better scores. However, they did not actually investigate  what effect the exercises had on
distribution of the water and ingested agents.
2. They claim that it was the exercises which led to improved visualisation. I think this is
overstated. If they were two historical cohorts, the pe protocol being the more recent one than the
original cmp protocol, there may be confounding factors which resulted in improved preparation
over time. These might include, for example, better adherence to preparation protocols as the
importance of these became better understood (including the omission of pre-procedure PPI
which may be associated with improved visualisation); better selection of appropriate patients
(the document describes excluding patients with cardiac, liver and renal disease, but the numbers
in each group  are not given and other conditions and medications which are associated with poor
gastric emptying such as diabetes, use of opioids, tricyclics etc are not described);  improving
MACE endoscopist skills (intragastric prep could be improved during the procedure by asking
patients to change position or drink more water). Therefore, at best, I would say that the exercises
might improve gastric prep, but that there are several confounding factors which cannot be
excluded and that a randomised trial is warranted.
3. As described in the first point above, movement of the intragastric content during the different
exercises was not studied, so the authors cannot say with confidence that the first set of
movements allowed the medication to reach the upper part of the gastric body and cardia etc
etc. It is possible that this might have occurred, but the study does not investigate this.
Title: Positioning exercises in improving the quality of Magnetic-controlled Capsule Endoscopy
Version: 1 Date: 09 Jul 2024
Reviewer's report:
The study is of interest and I agree with the authors that techniques to improve gastric preparation
which involve standing exercises such as those described are likely to be easier for patients to
comply with than distributing the intragastric water and simethicone by repeated rotations from
the supine to prone positions, which some find difficult.
It is not entirely clear, but as the document describes this as a retrospective study, I assume that
the two groups compared are historical cohorts in which the cmp-Group followed the original
protocol (n=159) which was changed at some point (to a pe protocol) following which all
followed the new protocol. (n= 148).
The pe protocol results in better cleanliness and mucosal visualisation compared  to the cmp
protocol. However, some of the claims are overstated because there are limitations to the study
which are not discussed and therefore, unwarranted conclusions are drawn:
1. The authors state that 'positioning exercises facilitated the distribution of defoaming and
mucolytic agents to more areas within the gastric cavity.' This might be inferred as the pe group
had better scores. However, they did not actually investigate  what effect the exercises had on
distribution of the water and ingested agents.
2. They claim that it was the exercises which led to improved visualisation. I think this is
overstated. If they were two historical cohorts, the pe protocol being the more recent one than the
original cmp protocol, there may be confounding factors which resulted in improved preparation
over time. These might include, for example, better adherence to preparation protocols as the
importance of these became better understood (including the omission of pre-procedure PPI
which may be associated with improved visualisation); better selection of appropriate patients
(the document describes excluding patients with cardiac, liver and renal disease, but the numbers
in each group  are not given and other conditions and medications which are associated with poor
gastric emptying such as diabetes, use of opioids, tricyclics etc are not described);  improving
MACE endoscopist skills (intragastric prep could be improved during the procedure by asking
patients to change position or drink more water). Therefore, at best, I would say that the exercises
might improve gastric prep, but that there are several confounding factors which cannot be
excluded and that a randomised trial is warranted.
3. As described in the first point above, movement of the intragastric content during the different
exercises was not studied, so the authors cannot say with confidence that the first set of
movements allowed the medication to reach the upper part of the gastric body and cardia etc
etc. It is possible that this might have occurred, but the study does not investigate this.
Please review this paper.
user
Title: Positioning exercises in improving the quality of Magnetic-controlled Capsule Endoscopy
Version: 1 Date: 09 Jul 2024
Reviewer's report:
The study is of interest and I agree with the authors that techniques to improve gastric preparation
which involve standing exercises such as those described are likely to be easier for patients to
comply with than distributing the intragastric water and simethicone by repeated rotations from
the supine to prone positions, which some find difficult.
It is not entirely clear, but as the document describes this as a retrospective study, I assume that
the two groups compared are historical cohorts in which the cmp-Group followed the original
protocol (n=159) which was changed at some point (to a pe protocol) following which all
followed the new protocol. (n= 148).
The pe protocol results in better cleanliness and mucosal visualisation compared  to the cmp
protocol. However, some of the claims are overstated because there are limitations to the study
which are not discussed and therefore, unwarranted conclusions are drawn:
1. The authors state that 'positioning exercises facilitated the distribution of defoaming and
mucolytic agents to more areas within the gastric cavity.' This might be inferred as the pe group
had better scores. However, they did not actually investigate  what effect the exercises had on
distribution of the water and ingested agents.
2. They claim that it was the exercises which led to improved visualisation. I think this is
overstated. If they were two historical cohorts, the pe protocol being the more recent one than the
original cmp protocol, there may be confounding factors which resulted in improved preparation
over time. These might include, for example, better adherence to preparation protocols as the
importance of these became better understood (including the omission of pre-procedure PPI
which may be associated with improved visualisation); better selection of appropriate patients
(the document describes excluding patients with cardiac, liver and renal disease, but the numbers
in each group  are not given and other conditions and medications which are associated with poor
gastric emptying such as diabetes, use of opioids, tricyclics etc are not described);  improving
MACE endoscopist skills (intragastric prep could be improved during the procedure by asking
patients to change position or drink more water). Therefore, at best, I would say that the exercises
might improve gastric prep, but that there are several confounding factors which cannot be
excluded and that a randomised trial is warranted.
3. As described in the first point above, movement of the intragastric content during the different
exercises was not studied, so the authors cannot say with confidence that the first set of
movements allowed the medication to reach the upper part of the gastric body and cardia etc
etc. It is possible that this might have occurred, but the study does not investigate this.
assistant