Reviewer’s report
Title:  The influence of various distractions prior to upper gastrointestinal endoscopy: A Prospective
Randomized Controlled Study
Version: 3 Date: 25 Jul 2018
Reviewer: Keng-Liang Wu
Reviewer's report:
Please include all comments  for the authors in this  box rather than uploading your report as an
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, supporting
materials or other aspects of your report which cannot be included in a text format.
Please overwrite this text when adding your comments to the authors.
This is a prospective randomized controlled study investigating the influence of distractions, audio and
visual distractions using subjective and objective methods and get the conclusion that audio distraction
alone and visual distraction alone were effective, a combination distraction was more effective in
improving physical and psychological factors by subjective and objective assessments. 
The below is my option for this manuscript. 
Received with major revision. 
Major:  
1.There  are  some  papers  studying  the  effect  of  distractions  on  scopy  (endoscopy,
colonoscopy etc) examination. The novelty and specificity of study is not good. 
2.Authors use objective and subjective assessments to study the effect of distractions
before upper GI endoscopy, but authors did not measure theses distractions with objective
assessments "during the GI endoscopy", the most important information for readers is the effect
of distractions during upper GI endoscopy and authors did not perform these assessments during
the endoscopy procedure.
Minor: 
1.Authors  should  describe  the  criterial  of  endoscopy specialists  clearly,  authors  only
described specialists had more than 7 year of experience in endoscopy, authors should describe
more clearly as more than 200 endoscopy / month.
2.The  experience  receiving  upper  GI  endoscopy  in  patients  is  important,  if  patients
receiving upper GI endoscopy before, he knew how unpleasure the procedure is. If patient has
no experience of endoscopy, he will be very anxiety.
3.Did  patient  receive  buscopan  (Hyoscine-N-Butylbromide)  before  endosocopy
procedure? It will induce tachycardia for patients. 
4.Table 2, Number of upper GI endoscopy examination should revise as "Number of upper
GI endoscopy experience" 
5.Authors should send English editor for English revision.
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.
Not relevant to this manuscript
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 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 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 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:  The influence of various distractions prior to upper gastrointestinal endoscopy: A Prospective
Randomized Controlled Study
Version: 3 Date: 25 Jul 2018
Reviewer: Keng-Liang Wu
Reviewer's report:
Please include all comments  for the authors in this  box rather than uploading your report as an
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, supporting
materials or other aspects of your report which cannot be included in a text format.
Please overwrite this text when adding your comments to the authors.
This is a prospective randomized controlled study investigating the influence of distractions, audio and
visual distractions using subjective and objective methods and get the conclusion that audio distraction
alone and visual distraction alone were effective, a combination distraction was more effective in
improving physical and psychological factors by subjective and objective assessments. 
The below is my option for this manuscript. 
Received with major revision. 
Major:  
1.There  are  some  papers  studying  the  effect  of  distractions  on  scopy  (endoscopy,
colonoscopy etc) examination. The novelty and specificity of study is not good. 
2.Authors use objective and subjective assessments to study the effect of distractions
before upper GI endoscopy, but authors did not measure theses distractions with objective
assessments "during the GI endoscopy", the most important information for readers is the effect
of distractions during upper GI endoscopy and authors did not perform these assessments during
the endoscopy procedure.
Minor: 
1.Authors  should  describe  the  criterial  of  endoscopy specialists  clearly,  authors  only
described specialists had more than 7 year of experience in endoscopy, authors should describe
more clearly as more than 200 endoscopy / month.
2.The  experience  receiving  upper  GI  endoscopy  in  patients  is  important,  if  patients
receiving upper GI endoscopy before, he knew how unpleasure the procedure is. If patient has
no experience of endoscopy, he will be very anxiety.
3.Did  patient  receive  buscopan  (Hyoscine-N-Butylbromide)  before  endosocopy
procedure? It will induce tachycardia for patients. 
4.Table 2, Number of upper GI endoscopy examination should revise as "Number of upper
GI endoscopy experience" 
5.Authors should send English editor for English revision.
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.
Not relevant to this manuscript
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 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 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 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:  The influence of various distractions prior to upper gastrointestinal endoscopy: A Prospective
Randomized Controlled Study
Version: 3 Date: 25 Jul 2018
Reviewer: Keng-Liang Wu
Reviewer's report:
Please include all comments  for the authors in this  box rather than uploading your report as an
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, supporting
materials or other aspects of your report which cannot be included in a text format.
Please overwrite this text when adding your comments to the authors.
This is a prospective randomized controlled study investigating the influence of distractions, audio and
visual distractions using subjective and objective methods and get the conclusion that audio distraction
alone and visual distraction alone were effective, a combination distraction was more effective in
improving physical and psychological factors by subjective and objective assessments. 
The below is my option for this manuscript. 
Received with major revision. 
Major:  
1.There  are  some  papers  studying  the  effect  of  distractions  on  scopy  (endoscopy,
colonoscopy etc) examination. The novelty and specificity of study is not good. 
2.Authors use objective and subjective assessments to study the effect of distractions
before upper GI endoscopy, but authors did not measure theses distractions with objective
assessments "during the GI endoscopy", the most important information for readers is the effect
of distractions during upper GI endoscopy and authors did not perform these assessments during
the endoscopy procedure.
Minor: 
1.Authors  should  describe  the  criterial  of  endoscopy specialists  clearly,  authors  only
described specialists had more than 7 year of experience in endoscopy, authors should describe
more clearly as more than 200 endoscopy / month.
2.The  experience  receiving  upper  GI  endoscopy  in  patients  is  important,  if  patients
receiving upper GI endoscopy before, he knew how unpleasure the procedure is. If patient has
no experience of endoscopy, he will be very anxiety.
3.Did  patient  receive  buscopan  (Hyoscine-N-Butylbromide)  before  endosocopy
procedure? It will induce tachycardia for patients. 
4.Table 2, Number of upper GI endoscopy examination should revise as "Number of upper
GI endoscopy experience" 
5.Authors should send English editor for English revision.
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.
Not relevant to this manuscript
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 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 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 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