Reviewer's report
Title:Use of an Electromagnetic Colonoscope to Assess Maneuvers Associated
with Cecal Intubation
Version: 1Date:9 October 2008
Reviewer: Michael Bretthauer
Reviewer's report:
The usefulness of different maneuvres during the insertion phase of colonoscopy
(patient repositioning, endoscop stiffening, external abdominal pressure) have
been described as helpful to intubate the ceacum and are widely used. However,
evidence for their effect are largely lacking. Therefore, the study by Heigh and
c-workers therefore deals with an important topic.
However, unfortunately, in my opinion, he study fails to address the
abovementioned issues properly and I would therefore recommend to reject the
paper.
Flaws:
1. the study lacks a clear statement of the study aim and an explanation of the
methods used to accomplish this aim. While a definiton of the study aim is
completely lacking in the introduction, the abstract states that the authors would
aim to "better understand how these maneuvres affect coecal intubation".
However, the study does not give any answers to that question. To address this,
the invetigators would have chosen a different design, allowing the reader to
distinguish between insertion with and witghout the attempted maneuvres and
their effect. A back-to-back desgin would have been the better approach.
2. Only about 1 patient per day has been included in the trial during the study
period. This questions the validity of the results as a selection bias must be
considered.
3. The choice of both the endoscopse used and the maneuvres applied are not
clear to the reader and may affect the outcome of the study.
3. the authors fail to acknowledge a number of papers that already exist on the
topic (e.g. Shah et al GIE 2002, Hoff et al Scand J Gastro 2007).
4. It is unclear how a success/non-success of the different maneuvres are
defined.
5. The use of the stiffening function is not explained (grade of stiffening)
6. statistics are lacking completely
7. the conclusion of the trial does not fit to the aim at all. Moreover, the trial
cannot tell anything about the usefulness of the Em endoscope with regard to
visualisation of the endoscope in realilty (however, other studies have lloked at
taht in the past).
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Use of an Electromagnetic Colonoscope to Assess Maneuvers Associated
with Cecal Intubation
Version: 1Date:9 October 2008
Reviewer: Michael Bretthauer
Reviewer's report:
The usefulness of different maneuvres during the insertion phase of colonoscopy
(patient repositioning, endoscop stiffening, external abdominal pressure) have
been described as helpful to intubate the ceacum and are widely used. However,
evidence for their effect are largely lacking. Therefore, the study by Heigh and
c-workers therefore deals with an important topic.
However, unfortunately, in my opinion, he study fails to address the
abovementioned issues properly and I would therefore recommend to reject the
paper.
Flaws:
1. the study lacks a clear statement of the study aim and an explanation of the
methods used to accomplish this aim. While a definiton of the study aim is
completely lacking in the introduction, the abstract states that the authors would
aim to "better understand how these maneuvres affect coecal intubation".
However, the study does not give any answers to that question. To address this,
the invetigators would have chosen a different design, allowing the reader to
distinguish between insertion with and witghout the attempted maneuvres and
their effect. A back-to-back desgin would have been the better approach.
2. Only about 1 patient per day has been included in the trial during the study
period. This questions the validity of the results as a selection bias must be
considered.
3. The choice of both the endoscopse used and the maneuvres applied are not
clear to the reader and may affect the outcome of the study.
3. the authors fail to acknowledge a number of papers that already exist on the
topic (e.g. Shah et al GIE 2002, Hoff et al Scand J Gastro 2007).
4. It is unclear how a success/non-success of the different maneuvres are
defined.
5. The use of the stiffening function is not explained (grade of stiffening)
6. statistics are lacking completely
7. the conclusion of the trial does not fit to the aim at all. Moreover, the trial
cannot tell anything about the usefulness of the Em endoscope with regard to
visualisation of the endoscope in realilty (however, other studies have lloked at
taht in the past).
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Use of an Electromagnetic Colonoscope to Assess Maneuvers Associated
with Cecal Intubation
Version: 1Date:9 October 2008
Reviewer: Michael Bretthauer
Reviewer's report:
The usefulness of different maneuvres during the insertion phase of colonoscopy
(patient repositioning, endoscop stiffening, external abdominal pressure) have
been described as helpful to intubate the ceacum and are widely used. However,
evidence for their effect are largely lacking. Therefore, the study by Heigh and
c-workers therefore deals with an important topic.
However, unfortunately, in my opinion, he study fails to address the
abovementioned issues properly and I would therefore recommend to reject the
paper.
Flaws:
1. the study lacks a clear statement of the study aim and an explanation of the
methods used to accomplish this aim. While a definiton of the study aim is
completely lacking in the introduction, the abstract states that the authors would
aim to "better understand how these maneuvres affect coecal intubation".
However, the study does not give any answers to that question. To address this,
the invetigators would have chosen a different design, allowing the reader to
distinguish between insertion with and witghout the attempted maneuvres and
their effect. A back-to-back desgin would have been the better approach.
2. Only about 1 patient per day has been included in the trial during the study
period. This questions the validity of the results as a selection bias must be
considered.
3. The choice of both the endoscopse used and the maneuvres applied are not
clear to the reader and may affect the outcome of the study.
3. the authors fail to acknowledge a number of papers that already exist on the
topic (e.g. Shah et al GIE 2002, Hoff et al Scand J Gastro 2007).
4. It is unclear how a success/non-success of the different maneuvres are
defined.
5. The use of the stiffening function is not explained (grade of stiffening)
6. statistics are lacking completely
7. the conclusion of the trial does not fit to the aim at all. Moreover, the trial
cannot tell anything about the usefulness of the Em endoscope with regard to
visualisation of the endoscope in realilty (however, other studies have lloked at
taht in the past).
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
assistant