Review Reports - Endoscopic Evaluation and Therapeutic Considerations of Small Bowel Crohn’s Disease

Round 1

Reviewer 1 Report

This is a very comprehensive literature review on the endoscopic evaluation of small bowel in Crohn’s disease. Overall, the authors used many important references to explain different aspects of each endoscopic method. I have a few comments/suggestions to improve the manuscript.

Can the authors explore the importance of small bowel evaluation as it relates to patient management? If a patient has presentation consistent with Crohn’s disease and hasn’t been undergone small bowel evaluation but is responding well to treatment, is it still critical to evaluate the small bowel using the methods described in the main text?
Please add broader implication of this review or how this review adds to the existing literature.
Some minor typos were spotted. Please correct them.

Author Response

The Editor

Gastroenterology Insights

Thank you for considering our paper "Endoscopic evaluation and therapeutic considerations of small bowel Crohn's disease" for publication in Gastroenterology Insights . We are grateful to you and the reviewers for the helpful comments.

Please find enclosed the revised version of the manuscript along with point-by-point response to the reviewers. We appreciate the opportunity to resubmit and hope that you find this version acceptable for publication.

Yours sincerely,

Partha Pal and Rupa Banerjee

Reviewers' comments:
Reviewer #1:

Thank you for your comment.

1Can the authors explore the importance of small bowel evaluation as it relates to patient management? If a patient has presentation consistent with Crohn’s disease and hasn’t been undergone small bowel evaluation but is responding well to treatment, is it still critical to evaluate the small bowel using the methods described in the main text?

Thank you for the insightful comment which is relevant to clinical practice. There has been a recently published study from Tokyo, Japan published in Journal of Gastroenterology which addresses this issue (Reference 84,Takabayashi K, Hosoe N, Kato M, et al . Significance of endoscopic deep small bowel evaluation using balloon-assisted enteroscopy for Crohn's disease in clinical remission. J Gastroenterol. 2021 Jan;56(1):25-33). This study explored the significance of endoscopic deep small bowel evaluation using balloon-assisted enteroscopy for Crohn’s disease in clinical remission. EndoscopicMultivariate logistic regression analysis revealed that the Harvey–Bradshaw Index and modified partial SES-CD at deep small bowel evaluation were independent predictors for relapse, whereas a SES-CD at the terminal ileum did not exhibit independence. Hence it was concluded that even when Crohn’s disease is in remission, it is important to evaluate DSB using BAE to assess endoscopic mucosal healing. As we are moving towards new treatment goals in Crohn disease (the STRIDE II consensus) in which long term treatment goal like endoscopic remission is important, small bowel evaluation is important in Crohn’s disease in clinical remission which does not guarantee endoscopic remission as well and limited ileo-scopy can be normal inspite of small bowel active disease.

We have elaborated this in the main text as well.

2Please add broader implication of this review or how this review adds to the existing literature.

Endoscopic evaluation of Small bowel Crohn’s disease is a rapidly evolving field with newer diagnostic technologies (like pan-enteric capsules, Artificial intelligence in capsule endoscopy, novel motorized spiral enteroscopy, balloon guided enteroscopy) and newer therapeutic avenues) like endoscopic electro-incision, stricture-plasty and stenting) coming up. This comprehensive review sums up the existing ever growing literature and highlights the way forward in this interesting field.

We have now added few lines in the abstract with regard to this.

3Some minor typos were spotted. Please correct them.

Thank you so much for pointing out. We have now proof read and corrected the typos.

Author Response File: Author Response.docx

Reviewer 2 Report

Interesting review of the literature, with detailed description
of endoscopic techniques for studying the small intestine compared
to cross-sectional radiological techniques.
Accurate explanation of the therapeutic possibilities of endoscopic methods.
Extensive and updated bibliography.
I believe that the paper can be accepted in this version, prior a careful
re-reading of the draft, for the not rare printing errors
(example: line 435 ASin for Asian or 403 oleo-cal and gasproduodenal for
ileo-cecal and gastroduodenal).

Author Response

The Editor

Gastroenterology Insights

Yours sincerely,

Partha Pal and Rupa Banerjee

Reviewers' comments:

Reviewer #2

Interesting review of the literature, with detailed description

of endoscopic techniques for studying the small intestine compared

to cross-sectional radiological techniques.

Accurate explanation of the therapeutic possibilities of endoscopic methods.

Extensive and updated bibliography.

I believe that the paper can be accepted in this version, prior a careful

re-reading of the draft, for the not rare printing errors

(example: line 435 ASin for Asian or 403 oleo-cal and gasproduodenal for

ileo-cecal and gastroduodenal).

Thank you so much for the appreciation and pointing out the mistakes. We have now proof read and corrected the typographical errors.

Author Response File: Author Response.docx