Reviewer's report
Title:The prone 12 o'clock position reduces ileal intubation time during
colonoscopy compared to the left lateral 6 o'clock (standard) position
Version: 1Date:6 June 2011
Reviewer: Anna Buchner
Reviewer's report:
The study by Dr De Silva and colleagues aims to compare the prone 12 o’clock
position with the standard left lateral 12 o’clock position for ileal intubation. It
consists of the pilot study of 10 patients in which using the fluoroscopy exam the
prone 12 o’clock position was determined to be the best for the ileocecal valve
location and then the second part in which 150 patients were randomized to
either ileal intubation in prone 12 o’clock position or left lateral 12 o’clock
position. It concludes that the prone 12 o’clock position represents a more
efficient (faster) approach for the ileocecal valve intubation.
The study raises a practical point of technique for ileal intubations. Overall it is an
interesting and practical concept though its clinical significance need to be further
clarified. Other studies, not quoted here report pathologic abnormalities in the
terminal ileum as low as 0.3% of all study patients (Kennedy G et al Surg
Endoscopy 2008).
The study is well written. It requires some major clarifications:
1. Was the time of ileal intubation related in anyway to the experience of the
endoscopists, the nursing staff and the whole team? Other studies did report the
significance of these confounding variables for ileal intubation.
2. How was the change of position executed- did it apply to the whole procedure
or to only time of the ileocecal valve intubation?
3. Did other confounding variables such as adequate bowel preparation, age of
the patients, gender etc. have had an impact on the finding of the prone 12
o’clock position being more efficient?
4. Was there was a learning curve for successful ileal intubation observed in both
groups?
5. Did the pilot part of the study consist of completely different patients or
whether these patients included any of 150 patients?
Minor essential revisions:
The discussion needs to also enlist all potential limitations including the argument
of the prior studies that ileoscopy can show abnormal findings for only 1% of the
patients ( Kennedy F Surg Endoscopy 2008) as well as lack of confounding
variables analyzed in the study (endoscopists, nurse, bowel prep etc) which
could also play an important role.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
declare that I have no competing interests'
Reviewer's report
Title:The prone 12 o'clock position reduces ileal intubation time during
colonoscopy compared to the left lateral 6 o'clock (standard) position
Version: 1Date:6 June 2011
Reviewer: Anna Buchner
Reviewer's report:
The study by Dr De Silva and colleagues aims to compare the prone 12 o’clock
position with the standard left lateral 12 o’clock position for ileal intubation. It
consists of the pilot study of 10 patients in which using the fluoroscopy exam the
prone 12 o’clock position was determined to be the best for the ileocecal valve
location and then the second part in which 150 patients were randomized to
either ileal intubation in prone 12 o’clock position or left lateral 12 o’clock
position. It concludes that the prone 12 o’clock position represents a more
efficient (faster) approach for the ileocecal valve intubation.
The study raises a practical point of technique for ileal intubations. Overall it is an
interesting and practical concept though its clinical significance need to be further
clarified. Other studies, not quoted here report pathologic abnormalities in the
terminal ileum as low as 0.3% of all study patients (Kennedy G et al Surg
Endoscopy 2008).
The study is well written. It requires some major clarifications:
1. Was the time of ileal intubation related in anyway to the experience of the
endoscopists, the nursing staff and the whole team? Other studies did report the
significance of these confounding variables for ileal intubation.
2. How was the change of position executed- did it apply to the whole procedure
or to only time of the ileocecal valve intubation?
3. Did other confounding variables such as adequate bowel preparation, age of
the patients, gender etc. have had an impact on the finding of the prone 12
o’clock position being more efficient?
4. Was there was a learning curve for successful ileal intubation observed in both
groups?
5. Did the pilot part of the study consist of completely different patients or
whether these patients included any of 150 patients?
Minor essential revisions:
The discussion needs to also enlist all potential limitations including the argument
of the prior studies that ileoscopy can show abnormal findings for only 1% of the
patients ( Kennedy F Surg Endoscopy 2008) as well as lack of confounding
variables analyzed in the study (endoscopists, nurse, bowel prep etc) which
could also play an important role.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:The prone 12 o'clock position reduces ileal intubation time during
colonoscopy compared to the left lateral 6 o'clock (standard) position
Version: 1Date:6 June 2011
Reviewer: Anna Buchner
Reviewer's report:
The study by Dr De Silva and colleagues aims to compare the prone 12 o’clock
position with the standard left lateral 12 o’clock position for ileal intubation. It
consists of the pilot study of 10 patients in which using the fluoroscopy exam the
prone 12 o’clock position was determined to be the best for the ileocecal valve
location and then the second part in which 150 patients were randomized to
either ileal intubation in prone 12 o’clock position or left lateral 12 o’clock
position. It concludes that the prone 12 o’clock position represents a more
efficient (faster) approach for the ileocecal valve intubation.
The study raises a practical point of technique for ileal intubations. Overall it is an
interesting and practical concept though its clinical significance need to be further
clarified. Other studies, not quoted here report pathologic abnormalities in the
terminal ileum as low as 0.3% of all study patients (Kennedy G et al Surg
Endoscopy 2008).
The study is well written. It requires some major clarifications:
1. Was the time of ileal intubation related in anyway to the experience of the
endoscopists, the nursing staff and the whole team? Other studies did report the
significance of these confounding variables for ileal intubation.
2. How was the change of position executed- did it apply to the whole procedure
or to only time of the ileocecal valve intubation?
3. Did other confounding variables such as adequate bowel preparation, age of
the patients, gender etc. have had an impact on the finding of the prone 12
o’clock position being more efficient?
4. Was there was a learning curve for successful ileal intubation observed in both
groups?
5. Did the pilot part of the study consist of completely different patients or
whether these patients included any of 150 patients?
Minor essential revisions:
The discussion needs to also enlist all potential limitations including the argument
of the prior studies that ileoscopy can show abnormal findings for only 1% of the
patients ( Kennedy F Surg Endoscopy 2008) as well as lack of confounding
variables analyzed in the study (endoscopists, nurse, bowel prep etc) which
could also play an important role.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
declare that I have no competing interests'
assistant