Reviewer’s report
Title: 
Characteristics and potential malignancy of colorectal juvenile polyps in
adults: A single-center retrospective study in China
Version: 
0 
Date: 
02 Dec 2021
Reviewer's report:
Manuscript Number: BMGE-D-21-00243
CHARACTERISTICS AND POTENTIAL MALIGNANCY OF
COLORECTAL JUVENILE POLYPS IN ADULTS: A SINGLE-CENTER
RETROSPECTIVE STUDY IN CHINA
The authors share their experience with patients with colorectal juvenile polyps
focusing, I guess, on their potential of malignancy. The topic sounds interesting,
and the manuscript easily readable. However, I have some concerns that may
negatively influence the value of the study and the possibility of being published
in its current form. 
METHODS
- I have not so much clear in my head which are the actual objectives of the
study. Did the authors want to show the incidence of malignant polyps in a
cohort of colorectal polyps? If yes, what I understood is that one polyp only was
strictly malignant? I invite the authors to clarify the aims of the study both in the
abstract and in the introduction/methods section.
- Patients older than 18 years were included. Was the diagnosis of juvenile polyp
done before or after that age? This has to be specified since , as authors
themselves stated, juvenile polyps are much more frequent in younger patients.
- I recommend the authors to investigate the existence of an association between
characteristics of polyps (i.e. location, size, histology, Paris) and variables like ,
for instance, patient's age, gender, complaints.
RESULTS
- I do not agree with the decision of the author of creating 2 groups with so much
unbalanced number of patients ? 101 vs 2 is too much unbalanced. Moreover,
they do not actually take into consideration this classification throughout the text.
This is a little bit confusing.
- "Five patients had a history of cancer. "Which type of cancer, any? What is the
clinical relevance of it?
- I do think that mucous in the stools is quite normal. Why do you consider it a
complaint?
- What do you mean by saying that 35 juvenile polyps were found by
colonoscopy upon examination?
- Please mention Paris classification among methods and add reference.
- Why was that one patient considered to have CCR before the operation?
- "One patient… one patient… the third patient…" are they the 3 patients who
underwent surgery? Please clarify.
- Please clarify the type of surgery and the reason why the surgical option was
chosen.
- Please detail the type of endoscopic procedure performed, the instruments used,
if prophylactic epinephrine injection (and at which concentration) and/or
hemostatic clip were performed for polypectomy, anesthesia, bowel preparation,
who was the main operator, etc 
- "Neoplasia or cancerization (see the abstract) was not associated with the
number of polyps", how can you state it if 2 patients only had multiple polyps?
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Yes
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.
'I declare that I have no competing interests'
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: 
Characteristics and potential malignancy of colorectal juvenile polyps in
adults: A single-center retrospective study in China
Version: 
0 
Date: 
02 Dec 2021
Reviewer's report:
Manuscript Number: BMGE-D-21-00243
CHARACTERISTICS AND POTENTIAL MALIGNANCY OF
COLORECTAL JUVENILE POLYPS IN ADULTS: A SINGLE-CENTER
RETROSPECTIVE STUDY IN CHINA
The authors share their experience with patients with colorectal juvenile polyps
focusing, I guess, on their potential of malignancy. The topic sounds interesting,
and the manuscript easily readable. However, I have some concerns that may
negatively influence the value of the study and the possibility of being published
in its current form. 
METHODS
- I have not so much clear in my head which are the actual objectives of the
study. Did the authors want to show the incidence of malignant polyps in a
cohort of colorectal polyps? If yes, what I understood is that one polyp only was
strictly malignant? I invite the authors to clarify the aims of the study both in the
abstract and in the introduction/methods section.
- Patients older than 18 years were included. Was the diagnosis of juvenile polyp
done before or after that age? This has to be specified since , as authors
themselves stated, juvenile polyps are much more frequent in younger patients.
- I recommend the authors to investigate the existence of an association between
characteristics of polyps (i.e. location, size, histology, Paris) and variables like ,
for instance, patient's age, gender, complaints.
RESULTS
- I do not agree with the decision of the author of creating 2 groups with so much
unbalanced number of patients ? 101 vs 2 is too much unbalanced. Moreover,
they do not actually take into consideration this classification throughout the text.
This is a little bit confusing.
- "Five patients had a history of cancer. "Which type of cancer, any? What is the
clinical relevance of it?
- I do think that mucous in the stools is quite normal. Why do you consider it a
complaint?
- What do you mean by saying that 35 juvenile polyps were found by
colonoscopy upon examination?
- Please mention Paris classification among methods and add reference.
- Why was that one patient considered to have CCR before the operation?
- "One patient… one patient… the third patient…" are they the 3 patients who
underwent surgery? Please clarify.
- Please clarify the type of surgery and the reason why the surgical option was
chosen.
- Please detail the type of endoscopic procedure performed, the instruments used,
if prophylactic epinephrine injection (and at which concentration) and/or
hemostatic clip were performed for polypectomy, anesthesia, bowel preparation,
who was the main operator, etc 
- "Neoplasia or cancerization (see the abstract) was not associated with the
number of polyps", how can you state it if 2 patients only had multiple polyps?
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 after the final decision on the manuscript has been made. 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
Yes
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.
'I declare that I have no competing interests'
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: 
Characteristics and potential malignancy of colorectal juvenile polyps in
adults: A single-center retrospective study in China
Version: 
0 
Date: 
02 Dec 2021
Reviewer's report:
Manuscript Number: BMGE-D-21-00243
CHARACTERISTICS AND POTENTIAL MALIGNANCY OF
COLORECTAL JUVENILE POLYPS IN ADULTS: A SINGLE-CENTER
RETROSPECTIVE STUDY IN CHINA
The authors share their experience with patients with colorectal juvenile polyps
focusing, I guess, on their potential of malignancy. The topic sounds interesting,
and the manuscript easily readable. However, I have some concerns that may
negatively influence the value of the study and the possibility of being published
in its current form. 
METHODS
- I have not so much clear in my head which are the actual objectives of the
study. Did the authors want to show the incidence of malignant polyps in a
cohort of colorectal polyps? If yes, what I understood is that one polyp only was
strictly malignant? I invite the authors to clarify the aims of the study both in the
abstract and in the introduction/methods section.
- Patients older than 18 years were included. Was the diagnosis of juvenile polyp
done before or after that age? This has to be specified since , as authors
themselves stated, juvenile polyps are much more frequent in younger patients.
- I recommend the authors to investigate the existence of an association between
characteristics of polyps (i.e. location, size, histology, Paris) and variables like ,
for instance, patient's age, gender, complaints.
RESULTS
- I do not agree with the decision of the author of creating 2 groups with so much
unbalanced number of patients ? 101 vs 2 is too much unbalanced. Moreover,
they do not actually take into consideration this classification throughout the text.
This is a little bit confusing.
- "Five patients had a history of cancer. "Which type of cancer, any? What is the
clinical relevance of it?
- I do think that mucous in the stools is quite normal. Why do you consider it a
complaint?
- What do you mean by saying that 35 juvenile polyps were found by
colonoscopy upon examination?
- Please mention Paris classification among methods and add reference.
- Why was that one patient considered to have CCR before the operation?
- "One patient… one patient… the third patient…" are they the 3 patients who
underwent surgery? Please clarify.
- Please clarify the type of surgery and the reason why the surgical option was
chosen.
- Please detail the type of endoscopic procedure performed, the instruments used,
if prophylactic epinephrine injection (and at which concentration) and/or
hemostatic clip were performed for polypectomy, anesthesia, bowel preparation,
who was the main operator, etc 
- "Neoplasia or cancerization (see the abstract) was not associated with the
number of polyps", how can you state it if 2 patients only had multiple polyps?
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 after the final decision on the manuscript has been made. 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
Yes
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.
'I declare that I have no competing interests'
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