An Additional 30-s Observation of the Right-Sided Colon Using a Novel Endoscopic System with Texture and Color Enhancement Imaging Decreases Polyp Miss Rates: A Multicenter Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is a retrospective observational inconsecutive study, which proposed add-30s novel endoscopic system with novel system (EVIS X1; Olympus Co.) with texture and color enhancement imaging (TXI) observation of the right-sided colon significantly improved adenoma and sessile serrated lesion (SSL) detection rate (ASDR) and adenoma detection rate (ADR).

I have some concern:

1. Broad incusing criteria including (1) symptoms such as abdominal pain, constipation, anemia, and hematochezia; (2) surveillance after resection of polyps or cancer; and (3) positive fecal occult The adenoma detection rate may be heterogeneous in the different risk. The higher detection rate may be higher in family history of colon cancer and positive fecal occult blood.
2. Besides, the limitation of detail characteristic of patients, some condition had been proposed high polyps in right side colon, such as insulin resistant, high Body Mass Index.
3. Near one quarter study groups did not give anti-spermatic medication, may be effect adenoma detection rate.
4. Furthermore, how many polyps were examined endoscopically but not histologically?

Author Response

Comments 1: Broad incusing criteria including (1) symptoms such as abdominal pain, constipation, anemia, and hematochezia; (2) surveillance after resection of polyps or cancer; and (3) positive fecal occult blood. The adenoma detection rate may be heterogeneous in the different risk. The higher detection rate may be higher in family history of colon cancer and positive fecal occult blood.

 

Answer: Thank you for your valuable comment. As you pointed out, the indication of the colonoscopy including positive fecal occult blood and family history are likely to affect the ADR. However, we did not analyze these factors in this study. We wrote this in the limitation section described below.

 

Limitation section

The indication of the colonoscopy including positive fecal occult blood and family history were not examined in this study though they were likely to affect the ADR.

 

Comments 2: Besides, the limitation of detail characteristic of patients, some condition had been proposed high polyps in right side colon, such as insulin resistant, high Body Mass Index.

 

Answer: We appreciate your comment. However, we are sorry that this study did not examine insulin resistance or body mass index. We wrote them in the limitation section.

 

Limitation section

Patient characteristics related to insulin resistance, including diabetes mellitus and body mass index, were not examined in this study, although these factors might be associated with right-sided polyps.

 

Comments 3: Near one quarter study groups did not give anti-spermatic medication, may be effect adenoma detection rate.

 

Answer: We analyzed the factors related to adenoma/SSL detection in Table 4. The results showed that the use of antispasmodic drugs was not associated with detection. However, we did not analyze factors related to ADR, including the use of antispasmodic drugs. We conducted this analysis in the new Table 5, which also showed that the use of antispasmodic drugs was not associated with ADR. We added the comments in the Result section.

 

Result section

In the analysis of factors related to ADR, the use of the novel scope also remained significant after PSM in the multivariate analysis (odds ratio: 2.11, 95% CI: 1.25–3.57; p = 0.01) (Table 5).

 

Comments 4: Furthermore, how many polyps were examined endoscopically but not histologically?

 

Answer: We appreciate your comment. As the reviewer pointed out, it is important how many polyps were examined endoscopically but not histopathology. However, we did not have accurate data about it. Approximately 20% of polyps were examined endoscopically. We wrote this in the limitation section.

 

Limitation section

Furthermore, approximately 20% of polyps were examined endoscopically but not histologically.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for opportunity to involve in peer-review of your article. The study is well-designed and interesting. This multicenter retrospective study investigates the efficacy of a 30-second additional observation using Texture and Color Enhancement Imaging (TXI) in improving adenoma detection rate (ADR) and adenoma and sessile serrated lesion detection rate (ASDR) in the right-sided colon. The topic is relevant and timely, considering ongoing efforts to reduce missed proximal colon lesions during colonoscopy. The results suggest that the Add-30s TXI method significantly improves detection rates with minimal additional time, positioning it as a practical enhancement to standard screening protocols. 

I have not major consern regarding this study, and I didn't see any flaw on methodology. Just re-check the aticle for some typos, for example line 48 'rght' ''i'' missed. 

Good lucks!

Author Response

Comments 1: I have not major consern regarding this study, and I didn't see any flaw on methodology. Just re-check the aticle for some typos, for example line 48 'rght' ''i'' missed.

Answer: Thank you for your comments. As your comment, we reviewed line 48 and corrected a typo. We checked the entire text for typos or spelling errors.