Title: Different imaging techniques' diagnostic efficacy for Crohn's disease activity and external
validation and comparison of MDCTAs, SES-CD and IBUS-SAS
Version: 1 Date: 16 Jul 2024
Reviewer:  Rui Sousa Magalhães
Reviewer's report:
I read with much interest the original article presented, focusing an external validation for
Crohn’s disease activity scores, namely the IBUS-SAS. The study comprises a single-center
retrospective cohort. The primary outcome was the external validation and comparison of
different CD disease activity scores (MCDTAs, SES-CD and IBUS-SAS). The manuscript is
very well written, the theme is uptodate and the results interesting.
Major points:
- If possible, the key words would benefit to be changed according to MESH terms.
Introduction:
- Regarding the sentence: “CTE/MRE is the most accurate imaging method for diagnosing CD
bowel lesions”, the manuscript would benefit a mention to small bowel capsule endoscopy and
enteroscopy, the gold-standard diagnostic methods for assessing small bowel in CD disease.
Methods:
- The authors characterize the study as retrospective. As I understood all the patients were
hospitalized. Do all your patients perform ultrasound, computed tomography and upper
endoscopy and ileocolonoscopy? Or how dis the authors collected the data?
- “Cal-protectin” should read Calprotectin.
- Can the authors specify the volume of partients with CD they observe regularly? In a temporal
space of more than 2 years the inclusion of only 126 patients is rather low.
- Regarding the clinical applicability of IBUS-SAS, how long it takes to perform an
examination?
- A perk of the study is the fact the authors did not separate different Montreal CD types in the
analysis. Can the authors comment on this? Do you have any comparative data?
- How did the authors access the homogeneity of the population?
Results:
- The SES-CD overall performed poorly than IBUS-SAS. The authors based the justification in
the transmural character of CD. Despite understanding the rational, it’s unusual that a patient
with moderate-severe CDAI will present with no mucosal involvement, a normal SES-CD and
an abnormal IBUS-SAS. Can the authors further explore this?
- Can the authors provide information regarding negative and positive predictive value?
- The sentence “Due to the invasive nature of endoscopy and related risks, the same patient
cannot be performed repeatedly” should be modified and restructured.
Discussion:
- The sentence: “IBUS-SAS, SES-CD, and MDCTEs had significant positive correlations with
CDAI (r = 0.874, r = 0.677, and r = 0.762, respectively), suggesting that the IBUS-SAS has
a more significant ability to predict treatment efficacy before a patient's clinical symptoms
resolve” would benefit from further clarification.
- Can the authors present any kind of protocol to clinically introduce IBUS-SAS in daily clinical
practice, for patient surveillance? Or is it only indicated in suspected agudization?
Title: Different imaging techniques' diagnostic efficacy for Crohn's disease activity and external
validation and comparison of MDCTAs, SES-CD and IBUS-SAS
Version: 1 Date: 16 Jul 2024
Reviewer:  Rui Sousa Magalhães
Reviewer's report:
I read with much interest the original article presented, focusing an external validation for
Crohn’s disease activity scores, namely the IBUS-SAS. The study comprises a single-center
retrospective cohort. The primary outcome was the external validation and comparison of
different CD disease activity scores (MCDTAs, SES-CD and IBUS-SAS). The manuscript is
very well written, the theme is uptodate and the results interesting.
Major points:
- If possible, the key words would benefit to be changed according to MESH terms.
Introduction:
- Regarding the sentence: “CTE/MRE is the most accurate imaging method for diagnosing CD
bowel lesions”, the manuscript would benefit a mention to small bowel capsule endoscopy and
enteroscopy, the gold-standard diagnostic methods for assessing small bowel in CD disease.
Methods:
- The authors characterize the study as retrospective. As I understood all the patients were
hospitalized. Do all your patients perform ultrasound, computed tomography and upper
endoscopy and ileocolonoscopy? Or how dis the authors collected the data?
- “Cal-protectin” should read Calprotectin.
- Can the authors specify the volume of partients with CD they observe regularly? In a temporal
space of more than 2 years the inclusion of only 126 patients is rather low.
- Regarding the clinical applicability of IBUS-SAS, how long it takes to perform an
examination?
- A perk of the study is the fact the authors did not separate different Montreal CD types in the
analysis. Can the authors comment on this? Do you have any comparative data?
- How did the authors access the homogeneity of the population?
Results:
- The SES-CD overall performed poorly than IBUS-SAS. The authors based the justification in
the transmural character of CD. Despite understanding the rational, it’s unusual that a patient
with moderate-severe CDAI will present with no mucosal involvement, a normal SES-CD and
an abnormal IBUS-SAS. Can the authors further explore this?
- Can the authors provide information regarding negative and positive predictive value?
- The sentence “Due to the invasive nature of endoscopy and related risks, the same patient
cannot be performed repeatedly” should be modified and restructured.
Discussion:
- The sentence: “IBUS-SAS, SES-CD, and MDCTEs had significant positive correlations with
CDAI (r = 0.874, r = 0.677, and r = 0.762, respectively), suggesting that the IBUS-SAS has
a more significant ability to predict treatment efficacy before a patient's clinical symptoms
resolve” would benefit from further clarification.
- Can the authors present any kind of protocol to clinically introduce IBUS-SAS in daily clinical
practice, for patient surveillance? Or is it only indicated in suspected agudization?
Please review this paper.
user
Title: Different imaging techniques' diagnostic efficacy for Crohn's disease activity and external
validation and comparison of MDCTAs, SES-CD and IBUS-SAS
Version: 1 Date: 16 Jul 2024
Reviewer:  Rui Sousa Magalhães
Reviewer's report:
I read with much interest the original article presented, focusing an external validation for
Crohn’s disease activity scores, namely the IBUS-SAS. The study comprises a single-center
retrospective cohort. The primary outcome was the external validation and comparison of
different CD disease activity scores (MCDTAs, SES-CD and IBUS-SAS). The manuscript is
very well written, the theme is uptodate and the results interesting.
Major points:
- If possible, the key words would benefit to be changed according to MESH terms.
Introduction:
- Regarding the sentence: “CTE/MRE is the most accurate imaging method for diagnosing CD
bowel lesions”, the manuscript would benefit a mention to small bowel capsule endoscopy and
enteroscopy, the gold-standard diagnostic methods for assessing small bowel in CD disease.
Methods:
- The authors characterize the study as retrospective. As I understood all the patients were
hospitalized. Do all your patients perform ultrasound, computed tomography and upper
endoscopy and ileocolonoscopy? Or how dis the authors collected the data?
- “Cal-protectin” should read Calprotectin.
- Can the authors specify the volume of partients with CD they observe regularly? In a temporal
space of more than 2 years the inclusion of only 126 patients is rather low.
- Regarding the clinical applicability of IBUS-SAS, how long it takes to perform an
examination?
- A perk of the study is the fact the authors did not separate different Montreal CD types in the
analysis. Can the authors comment on this? Do you have any comparative data?
- How did the authors access the homogeneity of the population?
Results:
- The SES-CD overall performed poorly than IBUS-SAS. The authors based the justification in
the transmural character of CD. Despite understanding the rational, it’s unusual that a patient
with moderate-severe CDAI will present with no mucosal involvement, a normal SES-CD and
an abnormal IBUS-SAS. Can the authors further explore this?
- Can the authors provide information regarding negative and positive predictive value?
- The sentence “Due to the invasive nature of endoscopy and related risks, the same patient
cannot be performed repeatedly” should be modified and restructured.
Discussion:
- The sentence: “IBUS-SAS, SES-CD, and MDCTEs had significant positive correlations with
CDAI (r = 0.874, r = 0.677, and r = 0.762, respectively), suggesting that the IBUS-SAS has
a more significant ability to predict treatment efficacy before a patient's clinical symptoms
resolve” would benefit from further clarification.
- Can the authors present any kind of protocol to clinically introduce IBUS-SAS in daily clinical
practice, for patient surveillance? Or is it only indicated in suspected agudization?
assistant