Reviewer’s report
Title: 
Routine colonoscopy may be needed for uncomplicated acute right colonic
diverticulitis
Version: 
2 
Date: 
12 Nov 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses one
or several testable research questions? (Brief or other article types: is there a
clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your
concerns sufficiently for you to now recommend the work as a technically sound
contribution? If not, can further revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: HAVE THE AUTHORS RESPONDED
ADEQUATELY TO EACH OF THE QUESTIONS YOU RAISED IN YOUR
COMMENTS 
YES 
the authors have nicely and comprehensively responded to both sets of
reviewers' questions 
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE
MANUSCRIPT 
YES the changes in the manuscript make the argument more clear and
appropriate
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED
MANUSCRIPT
I think 
this is an important paper 
because it shows a 13%incidence of
adenomatous polys in patients with acute right-sided diverticulitis 
and supports
routine follow up colonoscopy which otherwise might not have been suspected .
Also the importance of right sided diverticulitis in the Asian population needs to
be mentioned and discussed, because it is more common.
ADDITIONAL REQUESTS/SUGGESTIONS: 
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD
MAKE 
I have re-read the entire text
1. In the abstract you still use the word "advanced" adenoma line 37 I would
really suggest that you add a very short definition of "advanced adenoma " 
on
line 36 saying 
".those 
>10mm and those containing >25% villous components or
severe dysplasia" the reader cannot determine what you mean without this
defined here
2.lines 65-67 WELL DONE 
THIS NOW IS 
PERFECTLY CLEAR AND IS
IMPORTANT!!!
3. Line 122 can you specify where the diverticulitis were found? I think many
readers would want to know if they were only on the right side or were pan
colonic
4. Line 125 I would change to "was found in one male patient 6 weeks later after
he originally presented to our", 
then on line 127 after the word antibiotics I
suggest that you say" for a presumed diagnosis of uncomplicated right sided
acute diverticulitis" and I would move the next sentience starting with "CT
examination" and move it before the sentence on line 127 starting with "He was
admitted". This is much more clear
5. Line 133 round off the follow up to 680 days too few patients to claim a tenth
of a day!
6. 
Line 139 it sounds like you didn't 
get the results of these other 
patients treated
elsewhere yet on the limitations section lines 209-211 you apparently have these
data-- I would add them here.
7. Lines 142. Why not report the overall incidence of adenoma toys polys in the
<45 versus the >45?year old cohort so that the reader does not have to calculate
it themselves -- 
28/209 (13%) versus 51/121 (42%); 
you are going to make a
statement that all patients with right-sided acute diverticulitis should be
colonoscoped. And by reporting this here it will further support your contention
every reader will probably think that patients less than 45 may not need to be
colonoscoped!
8. Line 152 shouldn't you also report the rates for those < and > 45 years old
here? I really think so!
9. Line 161 
the incidence of acute diverticulitis is greater in Asians. Shouldn't
this be mentioned? There are articles in the literature to support this. The fact
that all your patients were Asian is both a limitation AND a strength I would add
that to the limitations section and add a full paragraph to the discussion stressing
this as an important study for the Asian population- remember not all physicians
reading this will have a totally Asian population and many may have few Asians
-it is in both these groups of physicians where your paper is very important.
10. Line 220 why not end that sentence with "even in those less than 45 years
old who had an incidence of adenomas of 13%" 
11. Table 1 why not also separate out those > and those < 45 years old
Table 2 if I were to calculate "advanced adenomas" from the table it would only
be 2 high grade and 1 severe dysplasia. 
Shouldn't you also have the number of
adenomas with 
>25% villous changes in this table? 
With these changes this will strengthen the your excellent paper!!!!
Publons Reviewer Recognition
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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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Routine colonoscopy may be needed for uncomplicated acute right colonic
diverticulitis
Version: 
2 
Date: 
12 Nov 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses one
or several testable research questions? (Brief or other article types: is there a
clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your
concerns sufficiently for you to now recommend the work as a technically sound
contribution? If not, can further revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: HAVE THE AUTHORS RESPONDED
ADEQUATELY TO EACH OF THE QUESTIONS YOU RAISED IN YOUR
COMMENTS 
YES 
the authors have nicely and comprehensively responded to both sets of
reviewers' questions 
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE
MANUSCRIPT 
YES the changes in the manuscript make the argument more clear and
appropriate
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED
MANUSCRIPT
I think 
this is an important paper 
because it shows a 13%incidence of
adenomatous polys in patients with acute right-sided diverticulitis 
and supports
routine follow up colonoscopy which otherwise might not have been suspected .
Also the importance of right sided diverticulitis in the Asian population needs to
be mentioned and discussed, because it is more common.
ADDITIONAL REQUESTS/SUGGESTIONS: 
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD
MAKE 
I have re-read the entire text
1. In the abstract you still use the word "advanced" adenoma line 37 I would
really suggest that you add a very short definition of "advanced adenoma " 
on
line 36 saying 
".those 
>10mm and those containing >25% villous components or
severe dysplasia" the reader cannot determine what you mean without this
defined here
2.lines 65-67 WELL DONE 
THIS NOW IS 
PERFECTLY CLEAR AND IS
IMPORTANT!!!
3. Line 122 can you specify where the diverticulitis were found? I think many
readers would want to know if they were only on the right side or were pan
colonic
4. Line 125 I would change to "was found in one male patient 6 weeks later after
he originally presented to our", 
then on line 127 after the word antibiotics I
suggest that you say" for a presumed diagnosis of uncomplicated right sided
acute diverticulitis" and I would move the next sentience starting with "CT
examination" and move it before the sentence on line 127 starting with "He was
admitted". This is much more clear
5. Line 133 round off the follow up to 680 days too few patients to claim a tenth
of a day!
6. 
Line 139 it sounds like you didn't 
get the results of these other 
patients treated
elsewhere yet on the limitations section lines 209-211 you apparently have these
data-- I would add them here.
7. Lines 142. Why not report the overall incidence of adenoma toys polys in the
<45 versus the >45?year old cohort so that the reader does not have to calculate
it themselves -- 
28/209 (13%) versus 51/121 (42%); 
you are going to make a
statement that all patients with right-sided acute diverticulitis should be
colonoscoped. And by reporting this here it will further support your contention
every reader will probably think that patients less than 45 may not need to be
colonoscoped!
8. Line 152 shouldn't you also report the rates for those < and > 45 years old
here? I really think so!
9. Line 161 
the incidence of acute diverticulitis is greater in Asians. Shouldn't
this be mentioned? There are articles in the literature to support this. The fact
that all your patients were Asian is both a limitation AND a strength I would add
that to the limitations section and add a full paragraph to the discussion stressing
this as an important study for the Asian population- remember not all physicians
reading this will have a totally Asian population and many may have few Asians
-it is in both these groups of physicians where your paper is very important.
10. Line 220 why not end that sentence with "even in those less than 45 years
old who had an incidence of adenomas of 13%" 
11. Table 1 why not also separate out those > and those < 45 years old
Table 2 if I were to calculate "advanced adenomas" from the table it would only
be 2 high grade and 1 severe dysplasia. 
Shouldn't you also have the number of
adenomas with 
>25% villous changes in this table? 
With these changes this will strengthen the your excellent paper!!!!
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Routine colonoscopy may be needed for uncomplicated acute right colonic
diverticulitis
Version: 
2 
Date: 
12 Nov 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses one
or several testable research questions? (Brief or other article types: is there a
clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your
concerns sufficiently for you to now recommend the work as a technically sound
contribution? If not, can further revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: HAVE THE AUTHORS RESPONDED
ADEQUATELY TO EACH OF THE QUESTIONS YOU RAISED IN YOUR
COMMENTS 
YES 
the authors have nicely and comprehensively responded to both sets of
reviewers' questions 
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE
MANUSCRIPT 
YES the changes in the manuscript make the argument more clear and
appropriate
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED
MANUSCRIPT
I think 
this is an important paper 
because it shows a 13%incidence of
adenomatous polys in patients with acute right-sided diverticulitis 
and supports
routine follow up colonoscopy which otherwise might not have been suspected .
Also the importance of right sided diverticulitis in the Asian population needs to
be mentioned and discussed, because it is more common.
ADDITIONAL REQUESTS/SUGGESTIONS: 
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD
MAKE 
I have re-read the entire text
1. In the abstract you still use the word "advanced" adenoma line 37 I would
really suggest that you add a very short definition of "advanced adenoma " 
on
line 36 saying 
".those 
>10mm and those containing >25% villous components or
severe dysplasia" the reader cannot determine what you mean without this
defined here
2.lines 65-67 WELL DONE 
THIS NOW IS 
PERFECTLY CLEAR AND IS
IMPORTANT!!!
3. Line 122 can you specify where the diverticulitis were found? I think many
readers would want to know if they were only on the right side or were pan
colonic
4. Line 125 I would change to "was found in one male patient 6 weeks later after
he originally presented to our", 
then on line 127 after the word antibiotics I
suggest that you say" for a presumed diagnosis of uncomplicated right sided
acute diverticulitis" and I would move the next sentience starting with "CT
examination" and move it before the sentence on line 127 starting with "He was
admitted". This is much more clear
5. Line 133 round off the follow up to 680 days too few patients to claim a tenth
of a day!
6. 
Line 139 it sounds like you didn't 
get the results of these other 
patients treated
elsewhere yet on the limitations section lines 209-211 you apparently have these
data-- I would add them here.
7. Lines 142. Why not report the overall incidence of adenoma toys polys in the
<45 versus the >45?year old cohort so that the reader does not have to calculate
it themselves -- 
28/209 (13%) versus 51/121 (42%); 
you are going to make a
statement that all patients with right-sided acute diverticulitis should be
colonoscoped. And by reporting this here it will further support your contention
every reader will probably think that patients less than 45 may not need to be
colonoscoped!
8. Line 152 shouldn't you also report the rates for those < and > 45 years old
here? I really think so!
9. Line 161 
the incidence of acute diverticulitis is greater in Asians. Shouldn't
this be mentioned? There are articles in the literature to support this. The fact
that all your patients were Asian is both a limitation AND a strength I would add
that to the limitations section and add a full paragraph to the discussion stressing
this as an important study for the Asian population- remember not all physicians
reading this will have a totally Asian population and many may have few Asians
-it is in both these groups of physicians where your paper is very important.
10. Line 220 why not end that sentence with "even in those less than 45 years
old who had an incidence of adenomas of 13%" 
11. Table 1 why not also separate out those > and those < 45 years old
Table 2 if I were to calculate "advanced adenomas" from the table it would only
be 2 high grade and 1 severe dysplasia. 
Shouldn't you also have the number of
adenomas with 
>25% villous changes in this table? 
With these changes this will strengthen the your excellent paper!!!!
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant