Title: IS CHEMODENERVATION WITH INCOBOTULINUMTOXINA AN
ALTERNATIVE TO INVASIVE CHRONIC ANAL FISSURE TREATMENTS?
Version: 2 Date: 04 Jun 2024
Reviewer:  Mohamed Farid
Reviewer's report:
dear author
your study which started early in 2017 was based on an old version of Clinical Practice Guideline
for the Management of Anal Fissures FROM the Clinical Practice Guidelines Committee of the
American Society of Colon and Rectal Surgeons, also in2017.
[which stated that Botulinum toxin has similar results compared with topical therapies as first-
line therapy for chronic anal fissures, and modest improvement in healing rates as second-
line therapy following treatment with topical therapies]. Grade of Recommendation: Strong
recommendation BASED on low- and very-low-quality evidence, 1C.
Unfortunately. these guidelines have been updated recently with Grade of recommendation:
strong recommendation BASED on moderate-quality evidence, 1B.
On the basis of multiple prospective randomized clinical trials and meta-analyses, with the
limitation of significant heterogeneity between studies, the available evidence supports a grade
1B
So, this prospective single centre study with only 31 patients completed the follow up period is
not adding benefit to the current updated guidelines
Title: IS CHEMODENERVATION WITH INCOBOTULINUMTOXINA AN
ALTERNATIVE TO INVASIVE CHRONIC ANAL FISSURE TREATMENTS?
Version: 2 Date: 04 Jun 2024
Reviewer:  Mohamed Farid
Reviewer's report:
dear author
your study which started early in 2017 was based on an old version of Clinical Practice Guideline
for the Management of Anal Fissures FROM the Clinical Practice Guidelines Committee of the
American Society of Colon and Rectal Surgeons, also in2017.
[which stated that Botulinum toxin has similar results compared with topical therapies as first-
line therapy for chronic anal fissures, and modest improvement in healing rates as second-
line therapy following treatment with topical therapies]. Grade of Recommendation: Strong
recommendation BASED on low- and very-low-quality evidence, 1C.
Unfortunately. these guidelines have been updated recently with Grade of recommendation:
strong recommendation BASED on moderate-quality evidence, 1B.
On the basis of multiple prospective randomized clinical trials and meta-analyses, with the
limitation of significant heterogeneity between studies, the available evidence supports a grade
1B
So, this prospective single centre study with only 31 patients completed the follow up period is
not adding benefit to the current updated guidelines
Please review this paper.
user
Title: IS CHEMODENERVATION WITH INCOBOTULINUMTOXINA AN
ALTERNATIVE TO INVASIVE CHRONIC ANAL FISSURE TREATMENTS?
Version: 2 Date: 04 Jun 2024
Reviewer:  Mohamed Farid
Reviewer's report:
dear author
your study which started early in 2017 was based on an old version of Clinical Practice Guideline
for the Management of Anal Fissures FROM the Clinical Practice Guidelines Committee of the
American Society of Colon and Rectal Surgeons, also in2017.
[which stated that Botulinum toxin has similar results compared with topical therapies as first-
line therapy for chronic anal fissures, and modest improvement in healing rates as second-
line therapy following treatment with topical therapies]. Grade of Recommendation: Strong
recommendation BASED on low- and very-low-quality evidence, 1C.
Unfortunately. these guidelines have been updated recently with Grade of recommendation:
strong recommendation BASED on moderate-quality evidence, 1B.
On the basis of multiple prospective randomized clinical trials and meta-analyses, with the
limitation of significant heterogeneity between studies, the available evidence supports a grade
1B
So, this prospective single centre study with only 31 patients completed the follow up period is
not adding benefit to the current updated guidelines
assistant