Reviewer ’s report  
 
Title: "Appropriateness of colonoscopy according to EPAGE II in a low resource setting: a cross 
sectional study from Sri Lanka"  
 
Version: 1 Date: 26 Feb 2018  
 
Reviewer: Adrian Cummins  
 
Reviewer's report:  
 
Abstract:  
lines 49 to 50. Delete first sentenc e. Meaningless statement.  
lines 52 -53: Substitute: This study assessed the appropriateness of colonoscopies in Sri Lanka.  
lines 73 -76: Substitute: 'Every one in ten colonoscopies was inappropriate and this was highest 
for chronic abdominal pain. However,  even in this group, 9.5% of colonoscopies yielded CRC.'  
 
Introduction  
I still think this could be reduced to 2 -3 short paragraphs as much of text could go in the 
Discussion  
 
Discussion  
Line 254: Delete 'As highlighted in the results'  
Line 264: Delete 'It was shown that' and begin 'The majority of ….'  
Lines 283 -284: Substitute 'We recommend that the indication for colonoscopy be based om 
evidence of appropriateness, age, family history, and alarm symptoms. The indication for 
subjects ag ed less than 50 y and without symptoms is dubious'. Delete lines 286 -292. 
Can the author make clear how local guidelines differ and are superior to international 
guidelines.  
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:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five year s 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 a ny 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 un derstand 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 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: "Appropriateness of colonoscopy according to EPAGE II in a low resource setting: a cross 
sectional study from Sri Lanka"  
 
Version: 1 Date: 26 Feb 2018  
 
Reviewer: Adrian Cummins  
 
Reviewer's report:  
 
Abstract:  
lines 49 to 50. Delete first sentenc e. Meaningless statement.  
lines 52 -53: Substitute: This study assessed the appropriateness of colonoscopies in Sri Lanka.  
lines 73 -76: Substitute: 'Every one in ten colonoscopies was inappropriate and this was highest 
for chronic abdominal pain. However,  even in this group, 9.5% of colonoscopies yielded CRC.'  
 
Introduction  
I still think this could be reduced to 2 -3 short paragraphs as much of text could go in the 
Discussion  
 
Discussion  
Line 254: Delete 'As highlighted in the results'  
Line 264: Delete 'It was shown that' and begin 'The majority of ….'  
Lines 283 -284: Substitute 'We recommend that the indication for colonoscopy be based om 
evidence of appropriateness, age, family history, and alarm symptoms. The indication for 
subjects ag ed less than 50 y and without symptoms is dubious'. Delete lines 286 -292. 
Can the author make clear how local guidelines differ and are superior to international 
guidelines.  
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:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five year s 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 a ny 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 un derstand 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 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: "Appropriateness of colonoscopy according to EPAGE II in a low resource setting: a cross 
sectional study from Sri Lanka"  
 
Version: 1 Date: 26 Feb 2018  
 
Reviewer: Adrian Cummins  
 
Reviewer's report:  
 
Abstract:  
lines 49 to 50. Delete first sentenc e. Meaningless statement.  
lines 52 -53: Substitute: This study assessed the appropriateness of colonoscopies in Sri Lanka.  
lines 73 -76: Substitute: 'Every one in ten colonoscopies was inappropriate and this was highest 
for chronic abdominal pain. However,  even in this group, 9.5% of colonoscopies yielded CRC.'  
 
Introduction  
I still think this could be reduced to 2 -3 short paragraphs as much of text could go in the 
Discussion  
 
Discussion  
Line 254: Delete 'As highlighted in the results'  
Line 264: Delete 'It was shown that' and begin 'The majority of ….'  
Lines 283 -284: Substitute 'We recommend that the indication for colonoscopy be based om 
evidence of appropriateness, age, family history, and alarm symptoms. The indication for 
subjects ag ed less than 50 y and without symptoms is dubious'. Delete lines 286 -292. 
Can the author make clear how local guidelines differ and are superior to international 
guidelines.  
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:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five year s 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 a ny 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 un derstand 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 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