Title: Establishment and Evaluation of a Nomogram Predicting Risks of Missed Diagnoses of
Colorectal Polyps
Version: 1 Date: 09 Jun 2022
Reviewer:  Babak Shokrani
Reviewer's report:
Very interesting study looking at a missed diagnosis of colorectal polyps during colonoscopy.
1- The author assumes the interval colorectal cancer is one of the consequences, however it does
not address the possibility of a fast growing cancer especially in the cecum. Colorectal cancer
after surveillance colonoscopy can be due to false-negative examination or fast growth! Some
previous studies (T F Gorski et. al. PMID: 10411433) showed the size, differentiation, and stage
of colorectal cancer in addition to the interval to diagnosis suggest that the majority of cancers
found during surveillance colonoscopy followed prior false-negative examinations.
2- Also it would be very interesting to look at the polyp architecture in addition of the size
and number. For example are sessile polyps were missed in higher frequency in compare to
pedunculated polyps? what about the  serrated polyps/lesions? which tend to be harder to identify
on endoscopy. Were there any differences in term of the pathological type of the polyp?
3- The study proposes a reference value for clinicians to analyse the risk of a missed diagnosis
of colorectal polyps in individuals, identify high-risk groups, and formulate appropriate follow-
up strategies. This would be very helpful and new.
4- The author concluded the factors for missed diagnoses included age, endoscopist experience,
bowel preparation, retroflected view, withdrawal time, number of polyps in the right colon.
These are more and less have been presented in the previous studies.
Title: Establishment and Evaluation of a Nomogram Predicting Risks of Missed Diagnoses of
Colorectal Polyps
Version: 1 Date: 09 Jun 2022
Reviewer:  Babak Shokrani
Reviewer's report:
Very interesting study looking at a missed diagnosis of colorectal polyps during colonoscopy.
1- The author assumes the interval colorectal cancer is one of the consequences, however it does
not address the possibility of a fast growing cancer especially in the cecum. Colorectal cancer
after surveillance colonoscopy can be due to false-negative examination or fast growth! Some
previous studies (T F Gorski et. al. PMID: 10411433) showed the size, differentiation, and stage
of colorectal cancer in addition to the interval to diagnosis suggest that the majority of cancers
found during surveillance colonoscopy followed prior false-negative examinations.
2- Also it would be very interesting to look at the polyp architecture in addition of the size
and number. For example are sessile polyps were missed in higher frequency in compare to
pedunculated polyps? what about the  serrated polyps/lesions? which tend to be harder to identify
on endoscopy. Were there any differences in term of the pathological type of the polyp?
3- The study proposes a reference value for clinicians to analyse the risk of a missed diagnosis
of colorectal polyps in individuals, identify high-risk groups, and formulate appropriate follow-
up strategies. This would be very helpful and new.
4- The author concluded the factors for missed diagnoses included age, endoscopist experience,
bowel preparation, retroflected view, withdrawal time, number of polyps in the right colon.
These are more and less have been presented in the previous studies.
Please review this paper.
user
Title: Establishment and Evaluation of a Nomogram Predicting Risks of Missed Diagnoses of
Colorectal Polyps
Version: 1 Date: 09 Jun 2022
Reviewer:  Babak Shokrani
Reviewer's report:
Very interesting study looking at a missed diagnosis of colorectal polyps during colonoscopy.
1- The author assumes the interval colorectal cancer is one of the consequences, however it does
not address the possibility of a fast growing cancer especially in the cecum. Colorectal cancer
after surveillance colonoscopy can be due to false-negative examination or fast growth! Some
previous studies (T F Gorski et. al. PMID: 10411433) showed the size, differentiation, and stage
of colorectal cancer in addition to the interval to diagnosis suggest that the majority of cancers
found during surveillance colonoscopy followed prior false-negative examinations.
2- Also it would be very interesting to look at the polyp architecture in addition of the size
and number. For example are sessile polyps were missed in higher frequency in compare to
pedunculated polyps? what about the  serrated polyps/lesions? which tend to be harder to identify
on endoscopy. Were there any differences in term of the pathological type of the polyp?
3- The study proposes a reference value for clinicians to analyse the risk of a missed diagnosis
of colorectal polyps in individuals, identify high-risk groups, and formulate appropriate follow-
up strategies. This would be very helpful and new.
4- The author concluded the factors for missed diagnoses included age, endoscopist experience,
bowel preparation, retroflected view, withdrawal time, number of polyps in the right colon.
These are more and less have been presented in the previous studies.
assistant