Reviewer's report
Title:Capsule Colonoscopy Increases Uptake of Colorectal Cancer Screening
Version: 2Date:7 March 2012
Reviewer: Pat M Lynch
Reviewer's report:
Summary:
Investigators in Germany tested the hypothesis that an offer of capsule
endoscopy through a major regional insurer, would increase the uptake of CRC
screening. Enrollees were offered description of pros and cons of capsule
colonoscopy (CC) and conventional optical colonoscopy (OC), with an offer to
undergo either test. Capsule was preferred by a 3:1 margin over OC. A large
number of invitees evidently underwent OC outside the scope of the program, so
the effect of the invitation was uncertain in this group. Adenoma detection rate
(by patient) was 26% in OC group and 9% in CC group. A survey was used to
identify bases for user preferences and post hoc satisfaction..
Critique:
This study marks an interesting addition to the armamentarium of approaches
taken to foster CRC screening, and likely the first to compare patient uptake of
CC when offered as an alternative to OC. The greater preference for CC in men
is perhaps not surprising and a consideration that could be used to leverage
greater screening participation, especially in men.
Limitations of the study are several, but nonfatal. There was an overall rather low
overall response rate, though likely not much lower than observed in other similar
trials. An effort to reach nonresponders to assess their reasons for
nonparticipation would have been helpful. Of the 15 with technically
unsatisfactory CC (“incomplete”), 6 underwent OC. The difference in adenoma
rate of 26% vs 9% in the OC vs CC groups was described as nonsignificant. This
is actually a fairly dramatic difference, with a nonsignificant outcome likely due to
sample size. Authors might wish to comment on this. A high proportion of polyps
found on CC were >1cm, whereas the OC-detected tended to be smaller. One
tends to assume this discrepancy may be due to relative insensitivity of CC for
subcentimeter polps. A comment about this would be worthwhile.
The authors do comment on the logistic challenges of following a CC positive
screen with OC in a timely enough way as to avoid reprepping the patient. It
would be helpful if the authors could comment on how explicitly this need to
reprep was explained to subjects, including the fact that this would be a needed
undertaking in about 5-20% of cases that would be positive or incomplete. The
combination of (apparent) insensitivity for polyps <1cm with CC and relatively
high rate of repeat CC would be thought to have accounted for a lower proportion
of CC uptake. Authors may wish to comment on this as well.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Capsule Colonoscopy Increases Uptake of Colorectal Cancer Screening
Version: 2Date:7 March 2012
Reviewer: Pat M Lynch
Reviewer's report:
Summary:
Investigators in Germany tested the hypothesis that an offer of capsule
endoscopy through a major regional insurer, would increase the uptake of CRC
screening. Enrollees were offered description of pros and cons of capsule
colonoscopy (CC) and conventional optical colonoscopy (OC), with an offer to
undergo either test. Capsule was preferred by a 3:1 margin over OC. A large
number of invitees evidently underwent OC outside the scope of the program, so
the effect of the invitation was uncertain in this group. Adenoma detection rate
(by patient) was 26% in OC group and 9% in CC group. A survey was used to
identify bases for user preferences and post hoc satisfaction..
Critique:
This study marks an interesting addition to the armamentarium of approaches
taken to foster CRC screening, and likely the first to compare patient uptake of
CC when offered as an alternative to OC. The greater preference for CC in men
is perhaps not surprising and a consideration that could be used to leverage
greater screening participation, especially in men.
Limitations of the study are several, but nonfatal. There was an overall rather low
overall response rate, though likely not much lower than observed in other similar
trials. An effort to reach nonresponders to assess their reasons for
nonparticipation would have been helpful. Of the 15 with technically
unsatisfactory CC (“incomplete”), 6 underwent OC. The difference in adenoma
rate of 26% vs 9% in the OC vs CC groups was described as nonsignificant. This
is actually a fairly dramatic difference, with a nonsignificant outcome likely due to
sample size. Authors might wish to comment on this. A high proportion of polyps
found on CC were >1cm, whereas the OC-detected tended to be smaller. One
tends to assume this discrepancy may be due to relative insensitivity of CC for
subcentimeter polps. A comment about this would be worthwhile.
The authors do comment on the logistic challenges of following a CC positive
screen with OC in a timely enough way as to avoid reprepping the patient. It
would be helpful if the authors could comment on how explicitly this need to
reprep was explained to subjects, including the fact that this would be a needed
undertaking in about 5-20% of cases that would be positive or incomplete. The
combination of (apparent) insensitivity for polyps <1cm with CC and relatively
high rate of repeat CC would be thought to have accounted for a lower proportion
of CC uptake. Authors may wish to comment on this as well.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Capsule Colonoscopy Increases Uptake of Colorectal Cancer Screening
Version: 2Date:7 March 2012
Reviewer: Pat M Lynch
Reviewer's report:
Summary:
Investigators in Germany tested the hypothesis that an offer of capsule
endoscopy through a major regional insurer, would increase the uptake of CRC
screening. Enrollees were offered description of pros and cons of capsule
colonoscopy (CC) and conventional optical colonoscopy (OC), with an offer to
undergo either test. Capsule was preferred by a 3:1 margin over OC. A large
number of invitees evidently underwent OC outside the scope of the program, so
the effect of the invitation was uncertain in this group. Adenoma detection rate
(by patient) was 26% in OC group and 9% in CC group. A survey was used to
identify bases for user preferences and post hoc satisfaction..
Critique:
This study marks an interesting addition to the armamentarium of approaches
taken to foster CRC screening, and likely the first to compare patient uptake of
CC when offered as an alternative to OC. The greater preference for CC in men
is perhaps not surprising and a consideration that could be used to leverage
greater screening participation, especially in men.
Limitations of the study are several, but nonfatal. There was an overall rather low
overall response rate, though likely not much lower than observed in other similar
trials. An effort to reach nonresponders to assess their reasons for
nonparticipation would have been helpful. Of the 15 with technically
unsatisfactory CC (“incomplete”), 6 underwent OC. The difference in adenoma
rate of 26% vs 9% in the OC vs CC groups was described as nonsignificant. This
is actually a fairly dramatic difference, with a nonsignificant outcome likely due to
sample size. Authors might wish to comment on this. A high proportion of polyps
found on CC were >1cm, whereas the OC-detected tended to be smaller. One
tends to assume this discrepancy may be due to relative insensitivity of CC for
subcentimeter polps. A comment about this would be worthwhile.
The authors do comment on the logistic challenges of following a CC positive
screen with OC in a timely enough way as to avoid reprepping the patient. It
would be helpful if the authors could comment on how explicitly this need to
reprep was explained to subjects, including the fact that this would be a needed
undertaking in about 5-20% of cases that would be positive or incomplete. The
combination of (apparent) insensitivity for polyps <1cm with CC and relatively
high rate of repeat CC would be thought to have accounted for a lower proportion
of CC uptake. Authors may wish to comment on this as well.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
assistant