Title: Diagnostic yield of esophagogastroduodenoscopy, colonoscopy, and small bowel
endoscopy in Thai adults with chronic diarrhea
Version: 1 Date: 30 May 2021
Reviewer's report:
Dear the Editor and authors,
I have reviewed the manuscript submission ID 35d401d3-bc5b-4dd1-8f8c-65051bed6548
entitled “Diagnostic performance of esophagogastroduodenoscopy, colonoscopy, and small
bowel endoscopy in Thai adults with chronic diarrhea” with interest. However, there are many
major concerns as the following items;
Major concerns
1. The main limitation of this study was an irrelevant data of recruitment period of patients with
negative EGD and colonoscopy and patients underwent small bowel study. Why did the authors
include the patients with chronic diarrhea from January 2008 to December 2012 but evaluate
patients who underwent subsequent small bowel endoscopy from January 2018 to December
2018? The authors should collect the data of patients with chronic diarrhea from 2008 to 2018
and analyzed the diagnostic performance of all endoscopic methods which had been performed
in that period.
2. The diagnostic performance of any instrument should be based on the gold standard of disease
diagnosis and presented as sensitivity, specificity, PPV, and NPV. What is the gold standard for
diagnosing chronic diarrhea of this study? If the authors would like to present only the positive
rate of each method, they should revise the title and methodology.
3. As the author mentioned in the discussion part that Ref. 7 have shown the predictors for
small bowel mucosal diseases, the following sentences should be revised; “Furthermore, since
small bowel endoscopy is invasive and not widely available, a decision to perform small bowel
endoscopy should be carefully made. Therefore, we evaluated predictive factors for small bowel
mucosal diseases in patients with negative EGD and colonoscopy who underwent small bowel
endoscopy in which diagnostic endoscopy would be of benefit.”
4. In Table 1, how did the authors prove that “Self-limiting colitis” was from infectious process?
5.  All numbers of patients in the result should be demonstrated as n/N (%) to make the readers
to follow the manuscript easier.
6. Dose the “PE” on page 11 stand for push enteroscopy? If yes, please put it in the bracket
behind the original word before using it.
7. In discussion part, the author said that “Furthermore, all positive findings were also detected if
ileocolonoscopy was performed,…….” This information is different from the result which said
that “All patients whose EGD found positive findings also had abnormal colonoscopic findings
except for one with lymphoma who underwent only EGD.” Please clarify.
8. Because this study was a retrospective study and collected small sample size from a sole
hospital, this may not proper to propose the Figure 3. Please consider omit the Figure 3 until
the data from prospective study with larger included patients is conducted and confirmed your
hypothesis.
Title: Diagnostic yield of esophagogastroduodenoscopy, colonoscopy, and small bowel
endoscopy in Thai adults with chronic diarrhea
Version: 1 Date: 30 May 2021
Reviewer's report:
Dear the Editor and authors,
I have reviewed the manuscript submission ID 35d401d3-bc5b-4dd1-8f8c-65051bed6548
entitled “Diagnostic performance of esophagogastroduodenoscopy, colonoscopy, and small
bowel endoscopy in Thai adults with chronic diarrhea” with interest. However, there are many
major concerns as the following items;
Major concerns
1. The main limitation of this study was an irrelevant data of recruitment period of patients with
negative EGD and colonoscopy and patients underwent small bowel study. Why did the authors
include the patients with chronic diarrhea from January 2008 to December 2012 but evaluate
patients who underwent subsequent small bowel endoscopy from January 2018 to December
2018? The authors should collect the data of patients with chronic diarrhea from 2008 to 2018
and analyzed the diagnostic performance of all endoscopic methods which had been performed
in that period.
2. The diagnostic performance of any instrument should be based on the gold standard of disease
diagnosis and presented as sensitivity, specificity, PPV, and NPV. What is the gold standard for
diagnosing chronic diarrhea of this study? If the authors would like to present only the positive
rate of each method, they should revise the title and methodology.
3. As the author mentioned in the discussion part that Ref. 7 have shown the predictors for
small bowel mucosal diseases, the following sentences should be revised; “Furthermore, since
small bowel endoscopy is invasive and not widely available, a decision to perform small bowel
endoscopy should be carefully made. Therefore, we evaluated predictive factors for small bowel
mucosal diseases in patients with negative EGD and colonoscopy who underwent small bowel
endoscopy in which diagnostic endoscopy would be of benefit.”
4. In Table 1, how did the authors prove that “Self-limiting colitis” was from infectious process?
5.  All numbers of patients in the result should be demonstrated as n/N (%) to make the readers
to follow the manuscript easier.
6. Dose the “PE” on page 11 stand for push enteroscopy? If yes, please put it in the bracket
behind the original word before using it.
7. In discussion part, the author said that “Furthermore, all positive findings were also detected if
ileocolonoscopy was performed,…….” This information is different from the result which said
that “All patients whose EGD found positive findings also had abnormal colonoscopic findings
except for one with lymphoma who underwent only EGD.” Please clarify.
8. Because this study was a retrospective study and collected small sample size from a sole
hospital, this may not proper to propose the Figure 3. Please consider omit the Figure 3 until
the data from prospective study with larger included patients is conducted and confirmed your
hypothesis.
Please review this paper.
user
Title: Diagnostic yield of esophagogastroduodenoscopy, colonoscopy, and small bowel
endoscopy in Thai adults with chronic diarrhea
Version: 1 Date: 30 May 2021
Reviewer's report:
Dear the Editor and authors,
I have reviewed the manuscript submission ID 35d401d3-bc5b-4dd1-8f8c-65051bed6548
entitled “Diagnostic performance of esophagogastroduodenoscopy, colonoscopy, and small
bowel endoscopy in Thai adults with chronic diarrhea” with interest. However, there are many
major concerns as the following items;
Major concerns
1. The main limitation of this study was an irrelevant data of recruitment period of patients with
negative EGD and colonoscopy and patients underwent small bowel study. Why did the authors
include the patients with chronic diarrhea from January 2008 to December 2012 but evaluate
patients who underwent subsequent small bowel endoscopy from January 2018 to December
2018? The authors should collect the data of patients with chronic diarrhea from 2008 to 2018
and analyzed the diagnostic performance of all endoscopic methods which had been performed
in that period.
2. The diagnostic performance of any instrument should be based on the gold standard of disease
diagnosis and presented as sensitivity, specificity, PPV, and NPV. What is the gold standard for
diagnosing chronic diarrhea of this study? If the authors would like to present only the positive
rate of each method, they should revise the title and methodology.
3. As the author mentioned in the discussion part that Ref. 7 have shown the predictors for
small bowel mucosal diseases, the following sentences should be revised; “Furthermore, since
small bowel endoscopy is invasive and not widely available, a decision to perform small bowel
endoscopy should be carefully made. Therefore, we evaluated predictive factors for small bowel
mucosal diseases in patients with negative EGD and colonoscopy who underwent small bowel
endoscopy in which diagnostic endoscopy would be of benefit.”
4. In Table 1, how did the authors prove that “Self-limiting colitis” was from infectious process?
5.  All numbers of patients in the result should be demonstrated as n/N (%) to make the readers
to follow the manuscript easier.
6. Dose the “PE” on page 11 stand for push enteroscopy? If yes, please put it in the bracket
behind the original word before using it.
7. In discussion part, the author said that “Furthermore, all positive findings were also detected if
ileocolonoscopy was performed,…….” This information is different from the result which said
that “All patients whose EGD found positive findings also had abnormal colonoscopic findings
except for one with lymphoma who underwent only EGD.” Please clarify.
8. Because this study was a retrospective study and collected small sample size from a sole
hospital, this may not proper to propose the Figure 3. Please consider omit the Figure 3 until
the data from prospective study with larger included patients is conducted and confirmed your
hypothesis.
assistant