Reviewer ’s report  
 
Title: The Effect of Quality of Segmental Bowel preparation on Adenoma Detection Rate  
 
Version: 1 Date: 31 Dec 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
Yes - there is a clear objective  
 
DESIGN - Is the current approach (including controls  and analysis protocols) appropriate for the 
objective?  
No - there are minor issues  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
Yes - experiments and analyses were performed appropriately  
 
Statistics - Is the use of statistics in the manuscript appropriate?  
Yes - appropriate statistical analyses have been used in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
No - there ar e minor issues  
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
GENERAL COMMENTS: Overall Imp ression  
This study was a very comprehensive analysis of the detection rate of colonic polyps based on 
several scoring systems of completeness of bowel preparation. Overall, this study supports many 
other studies of accuracy of detection rate of polyps base d on the completeness of bowel 
preparation. The novel added finding  is  those of the evalution of luminal  bubbles which has not 
been evaluated before during colonoscopy. The question is whether this study adds novel and 
important new data; however,  this  evaluation of bubbles may reinforce the need to add 
simethicone to the bowel preparation used in  in China and this may be the most important 
finding of this  study.  
 
What have the authors done well  
The analysis is complete and comprehensive in terms of s coring of the segments of the colon by 
several different scoring systems as well as the accuracy of  detection also by several methods. 
The scoring based on experience is also unique.  
 
In what ways does it not meet best practice  
There really is no questio n of best practice  but rather the question of whether the analysis is 
complete. What is lacking is the  consideration of whether the size or type of polyp is important 
in being overlooked according to the completeness of bowel preparation and especially s o in the 
right colon  
 
REQUESTED REVISIONS:  
Are there additional revisions the authors should make -consider  
1. 1.Your abbreviations on page 3 line 17 need to be defined - yes most all readers will 
recognize these but not all  
 
2. Need to define the abbreviations in the text as well as just in the abstract  
 
3. The real question is whether the point you raise on page 3 lines 30 -34 is really that novel or 
important.  
 
4. Why exclude bowel preps other than PEG?  
 
5. Page 5 line 3 and pag e 6 line 12 change gender to sex. Gender is the phenotype sex is the 
genotype  
 
6. Page 10 Lines 26 -48 you are assuming that if the number of patients studied with these 
regions had increased that you would have seen a statistically significant difference - that is 
not appropriate - it is also possible that with a greater number of patients you would NOT 
have seen a difference ( purely a statistical argument that you cannot make without doing the 
study) . This paragraph should be shortened to one sentence sayin g that if the number of 
patients at had been greater  you "might" have been able to show a difference! This is an 
important point that needs to be changed.  
 
7. Page 10 line 50+ are there data that show that simethicone decreases bubbles ? If so add a 
refere nce here this may be one of your most important findings to Chinese colonoscopy!  
 
8. Why didn't  you analyze the importance of polyp size, type of polyp - pedunculated versus 
sessile as well as overall difference in detection rate? you have these data and th is may prove 
to be as important because the sessile polyps are more worrisome!  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
See  above suggestions  
Note: This reviewer report can be downloaded - see attached pdf file.  
Are the methods appropriate an d well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
  
Are the conclus ions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical rev iew 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 m anuscript, 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.  
 
This reviewer has been recruited by a partner or ganization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Research Sq uare and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on 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 C reative 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 Effect of Quality of Segmental Bowel preparation on Adenoma Detection Rate  
 
Version: 1 Date: 31 Dec 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
Yes - there is a clear objective  
 
DESIGN - Is the current approach (including controls  and analysis protocols) appropriate for the 
objective?  
No - there are minor issues  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
Yes - experiments and analyses were performed appropriately  
 
Statistics - Is the use of statistics in the manuscript appropriate?  
Yes - appropriate statistical analyses have been used in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
No - there ar e minor issues  
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
GENERAL COMMENTS: Overall Imp ression  
This study was a very comprehensive analysis of the detection rate of colonic polyps based on 
several scoring systems of completeness of bowel preparation. Overall, this study supports many 
other studies of accuracy of detection rate of polyps base d on the completeness of bowel 
preparation. The novel added finding  is  those of the evalution of luminal  bubbles which has not 
been evaluated before during colonoscopy. The question is whether this study adds novel and 
important new data; however,  this  evaluation of bubbles may reinforce the need to add 
simethicone to the bowel preparation used in  in China and this may be the most important 
finding of this  study.  
 
What have the authors done well  
The analysis is complete and comprehensive in terms of s coring of the segments of the colon by 
several different scoring systems as well as the accuracy of  detection also by several methods. 
The scoring based on experience is also unique.  
 
In what ways does it not meet best practice  
There really is no questio n of best practice  but rather the question of whether the analysis is 
complete. What is lacking is the  consideration of whether the size or type of polyp is important 
in being overlooked according to the completeness of bowel preparation and especially s o in the 
right colon  
 
REQUESTED REVISIONS:  
Are there additional revisions the authors should make -consider  
1. 1.Your abbreviations on page 3 line 17 need to be defined - yes most all readers will 
recognize these but not all  
 
2. Need to define the abbreviations in the text as well as just in the abstract  
 
3. The real question is whether the point you raise on page 3 lines 30 -34 is really that novel or 
important.  
 
4. Why exclude bowel preps other than PEG?  
 
5. Page 5 line 3 and pag e 6 line 12 change gender to sex. Gender is the phenotype sex is the 
genotype  
 
6. Page 10 Lines 26 -48 you are assuming that if the number of patients studied with these 
regions had increased that you would have seen a statistically significant difference - that is 
not appropriate - it is also possible that with a greater number of patients you would NOT 
have seen a difference ( purely a statistical argument that you cannot make without doing the 
study) . This paragraph should be shortened to one sentence sayin g that if the number of 
patients at had been greater  you "might" have been able to show a difference! This is an 
important point that needs to be changed.  
 
7. Page 10 line 50+ are there data that show that simethicone decreases bubbles ? If so add a 
refere nce here this may be one of your most important findings to Chinese colonoscopy!  
 
8. Why didn't  you analyze the importance of polyp size, type of polyp - pedunculated versus 
sessile as well as overall difference in detection rate? you have these data and th is may prove 
to be as important because the sessile polyps are more worrisome!  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
See  above suggestions  
Note: This reviewer report can be downloaded - see attached pdf file.  
Are the methods appropriate an d well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
  
Are the conclus ions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical rev iew 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 m anuscript, 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.  
 
This reviewer has been recruited by a partner or ganization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Research Sq uare and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on 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 C reative 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 Effect of Quality of Segmental Bowel preparation on Adenoma Detection Rate  
 
Version: 1 Date: 31 Dec 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
Yes - there is a clear objective  
 
DESIGN - Is the current approach (including controls  and analysis protocols) appropriate for the 
objective?  
No - there are minor issues  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
Yes - experiments and analyses were performed appropriately  
 
Statistics - Is the use of statistics in the manuscript appropriate?  
Yes - appropriate statistical analyses have been used in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
No - there ar e minor issues  
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
GENERAL COMMENTS: Overall Imp ression  
This study was a very comprehensive analysis of the detection rate of colonic polyps based on 
several scoring systems of completeness of bowel preparation. Overall, this study supports many 
other studies of accuracy of detection rate of polyps base d on the completeness of bowel 
preparation. The novel added finding  is  those of the evalution of luminal  bubbles which has not 
been evaluated before during colonoscopy. The question is whether this study adds novel and 
important new data; however,  this  evaluation of bubbles may reinforce the need to add 
simethicone to the bowel preparation used in  in China and this may be the most important 
finding of this  study.  
 
What have the authors done well  
The analysis is complete and comprehensive in terms of s coring of the segments of the colon by 
several different scoring systems as well as the accuracy of  detection also by several methods. 
The scoring based on experience is also unique.  
 
In what ways does it not meet best practice  
There really is no questio n of best practice  but rather the question of whether the analysis is 
complete. What is lacking is the  consideration of whether the size or type of polyp is important 
in being overlooked according to the completeness of bowel preparation and especially s o in the 
right colon  
 
REQUESTED REVISIONS:  
Are there additional revisions the authors should make -consider  
1. 1.Your abbreviations on page 3 line 17 need to be defined - yes most all readers will 
recognize these but not all  
 
2. Need to define the abbreviations in the text as well as just in the abstract  
 
3. The real question is whether the point you raise on page 3 lines 30 -34 is really that novel or 
important.  
 
4. Why exclude bowel preps other than PEG?  
 
5. Page 5 line 3 and pag e 6 line 12 change gender to sex. Gender is the phenotype sex is the 
genotype  
 
6. Page 10 Lines 26 -48 you are assuming that if the number of patients studied with these 
regions had increased that you would have seen a statistically significant difference - that is 
not appropriate - it is also possible that with a greater number of patients you would NOT 
have seen a difference ( purely a statistical argument that you cannot make without doing the 
study) . This paragraph should be shortened to one sentence sayin g that if the number of 
patients at had been greater  you "might" have been able to show a difference! This is an 
important point that needs to be changed.  
 
7. Page 10 line 50+ are there data that show that simethicone decreases bubbles ? If so add a 
refere nce here this may be one of your most important findings to Chinese colonoscopy!  
 
8. Why didn't  you analyze the importance of polyp size, type of polyp - pedunculated versus 
sessile as well as overall difference in detection rate? you have these data and th is may prove 
to be as important because the sessile polyps are more worrisome!  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
See  above suggestions  
Note: This reviewer report can be downloaded - see attached pdf file.  
Are the methods appropriate an d well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
  
Are the conclus ions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical rev iew 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 m anuscript, 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.  
 
This reviewer has been recruited by a partner or ganization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Research Sq uare and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on 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 C reative 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