Title: Appropriateness of Colonoscopies in a Tunisian Endoscopy Center: Factors and EPAGE-
I/II Criteria Comparison
Version: 4 Date: 21 Jun 2024
Reviewer's report:
It is a single center cross-sectional study aimed to compare appropriateness of colonoscopy by
means of European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) I
and II criteria. The authors observed appropriate colonoscopies in 43.2% and 76.4% when they
applied EPAGE I and II criteria respectively. Further, they noted a low agreement between the
EPAGE I and II (k=0.15). They concluded that EPAGE II criteria is a valid tool for reducing
inappropriate colonoscopies. However, the EPAGE II criteria were published in 2009 and are
not nowadays completely applicable because of the new recommendations on surveillance
after polypectomy (Rutter MD, et al. Gut 2020;69:201–223. doi:10.1136/gutjnl-2019-319858;
Hassan Cesare et al. Post-polypectomy colonoscopy surveillance: ESGE Guideline Update
2020). This concept should be mentioned in the discussion.
Maior revisions
1- In table 2, surveillance post polypectomy, there are different value in comparison to the text !
(1.7% vs 19.7% and 34% vs 27.4% (which are true ??)
2- In line 19 : “ On univariate analysis… “ the authors should insert values and statistics
demonstrating that  “…appropriate indication was associated with age (> 50 years) but not
with gender, with both sets of criteria. Appropriateness of indication was significantly higher
in hospitalized patients”
Minor revisions:
1- Please insert number page in your manuscript
2- The aim should be correct because of the appropriateness of colonoscopy is established by
EPAGE criteria (in your sentence it seems that you are applying another criterium).
3- In table 1, 7th  line is written in French language.
4- In table 1, specify the following abbreviations (head of table): AN, A, U, I, NA as well as in
table 3; specify that in the brackets is the value in percentage.
5- In table 2, line 3, there is a different value 23.3% in comparison to the text (23.3%).
6- In table 4 , insert 95%CI and specify the CCR abbreviation.
Title: Appropriateness of Colonoscopies in a Tunisian Endoscopy Center: Factors and EPAGE-
I/II Criteria Comparison
Version: 4 Date: 21 Jun 2024
Reviewer's report:
It is a single center cross-sectional study aimed to compare appropriateness of colonoscopy by
means of European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) I
and II criteria. The authors observed appropriate colonoscopies in 43.2% and 76.4% when they
applied EPAGE I and II criteria respectively. Further, they noted a low agreement between the
EPAGE I and II (k=0.15). They concluded that EPAGE II criteria is a valid tool for reducing
inappropriate colonoscopies. However, the EPAGE II criteria were published in 2009 and are
not nowadays completely applicable because of the new recommendations on surveillance
after polypectomy (Rutter MD, et al. Gut 2020;69:201–223. doi:10.1136/gutjnl-2019-319858;
Hassan Cesare et al. Post-polypectomy colonoscopy surveillance: ESGE Guideline Update
2020). This concept should be mentioned in the discussion.
Maior revisions
1- In table 2, surveillance post polypectomy, there are different value in comparison to the text !
(1.7% vs 19.7% and 34% vs 27.4% (which are true ??)
2- In line 19 : “ On univariate analysis… “ the authors should insert values and statistics
demonstrating that  “…appropriate indication was associated with age (> 50 years) but not
with gender, with both sets of criteria. Appropriateness of indication was significantly higher
in hospitalized patients”
Minor revisions:
1- Please insert number page in your manuscript
2- The aim should be correct because of the appropriateness of colonoscopy is established by
EPAGE criteria (in your sentence it seems that you are applying another criterium).
3- In table 1, 7th  line is written in French language.
4- In table 1, specify the following abbreviations (head of table): AN, A, U, I, NA as well as in
table 3; specify that in the brackets is the value in percentage.
5- In table 2, line 3, there is a different value 23.3% in comparison to the text (23.3%).
6- In table 4 , insert 95%CI and specify the CCR abbreviation.
Please review this paper.
user
Title: Appropriateness of Colonoscopies in a Tunisian Endoscopy Center: Factors and EPAGE-
I/II Criteria Comparison
Version: 4 Date: 21 Jun 2024
Reviewer's report:
It is a single center cross-sectional study aimed to compare appropriateness of colonoscopy by
means of European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) I
and II criteria. The authors observed appropriate colonoscopies in 43.2% and 76.4% when they
applied EPAGE I and II criteria respectively. Further, they noted a low agreement between the
EPAGE I and II (k=0.15). They concluded that EPAGE II criteria is a valid tool for reducing
inappropriate colonoscopies. However, the EPAGE II criteria were published in 2009 and are
not nowadays completely applicable because of the new recommendations on surveillance
after polypectomy (Rutter MD, et al. Gut 2020;69:201–223. doi:10.1136/gutjnl-2019-319858;
Hassan Cesare et al. Post-polypectomy colonoscopy surveillance: ESGE Guideline Update
2020). This concept should be mentioned in the discussion.
Maior revisions
1- In table 2, surveillance post polypectomy, there are different value in comparison to the text !
(1.7% vs 19.7% and 34% vs 27.4% (which are true ??)
2- In line 19 : “ On univariate analysis… “ the authors should insert values and statistics
demonstrating that  “…appropriate indication was associated with age (> 50 years) but not
with gender, with both sets of criteria. Appropriateness of indication was significantly higher
in hospitalized patients”
Minor revisions:
1- Please insert number page in your manuscript
2- The aim should be correct because of the appropriateness of colonoscopy is established by
EPAGE criteria (in your sentence it seems that you are applying another criterium).
3- In table 1, 7th  line is written in French language.
4- In table 1, specify the following abbreviations (head of table): AN, A, U, I, NA as well as in
table 3; specify that in the brackets is the value in percentage.
5- In table 2, line 3, there is a different value 23.3% in comparison to the text (23.3%).
6- In table 4 , insert 95%CI and specify the CCR abbreviation.
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