05774529

May 17, 2021, 06:13

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

Fecal incontinence (FI) causes severe psychological and financial burden, and extremely reduced the patients’ quality of life. The true incidence of FI may be underestimated. The present review gave a brief introduction of the etiology of FI in adults, and described several commonly used methods for the evaluation of FI. However, based on our clinical experience, we believe that some related information were not sufficiently discussed in this article. 1. Causes and risk factors FI is a multifactorial disease. In this section, the authors listed the main causes and risk factors of FI. We noticed that fecal impaction and impaired rectal compliance were not mentioned, yet they are also common causes of FI. It would be better to categorize the causes of FI according to the main mechanisms instead of simply make a list of all the related diseases. The header of Table 1 was missing, and the first row of content was incorrectly bolded. Besides, there were some language mistakes or typo's in Table 1. ‘Congenital/ Acquired neurological’ should be ‘Congenital/ Acquired neurological disease’, and ‘Ana cancer’ was probably a misspelling of “Anal cancer”. 2. History taking & physical examination In this part, the authors summarized the key informations that should be collected during history taking. In our perspective, there is still one thing to add. Since the stool form is an influencing factor of the continence mechanism that cannot be neglected, it would be better to assess the stool form with varified universal scales, e.g. Bristol stool form scale. What’s more, the severity of FI should also be quantified with patient reported scales. The content in this section was too general to be used as a ‘practical tool box’. A checklist which covers the main points of history taking will be more helpful in clinical practise. Japanese Practice Guidelines for Fecal Incontinence has given a great example in this aspect. 3. Diagnostic tools The authors gave a very comprehensive introduction of commonly used clinical diagnostic and assessment tools of FI, including HRAM, EAUS & MRI, as well as electromyography. As far as we know, defecography is an important method in assessing the morphological movement of rectum and the pelvic floor muscles. Unfortunately, in this section, the introduction of MRI defecography was too brief, and failed to reveal its role in disease diagnosis and surgical intervention sufficiently. Nevertheless, barium defecography was not mentioned. The last figure of this review showed a stepwise approach of faecal incontinence investigation, which may contribute to better clinical decision making. In conclusion, this review provided an comprehensive overview of FI, but the main weakness of it was the missing of some significant information and the lack of novelty. Space limitation may be responsible for this disadvantage. We sincerely looking forward to the authors’ future work. Xiyue Hu, M.D., Zheng Liu, M.D. Dept. of Colorectal Surgery National Cancer Center/ Cancer Hospital, Chinese Academy of Medical Science 17 Panjiayuan Nanli, Chaoyang District, Beijing, China, 100021

First, thank you very much for your professional comments on the article published in World Journal of Gastroenterology. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Gastroenterology at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.

03967085

May 15, 2021, 13:35

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

Concise and comprehensive paper. Valid conclusions that are beneficial for the clinical practice.

Thank you very much for your comments.

05625818

May 03, 2021, 00:26

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

The mini review of a meaningful study for daily practice of polypectomy, ESD and EMR. I suggest to accpeted

Thank you very much for your comments.

05770067

April 26, 2021, 08:53

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

Comment on “Diagnostic approach to faecal incontinence: What test and when to perform?” Jiangtao Wang1, Yandong Miao1, Quanlin Guan1,2* 1 The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, PR China 2 Department of Oncology Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, PR China * Corresponding Author: Quanlin Guan Email address: guanquanlin@yeah.net Abstract We recently read with interest the article "Diagnostic approach to faecal incontinence: What test and when to perform?" by Sbeit et al. This is a comprehensive and practical review, which has certain significance for guiding clinicians to improve the examination strategy. Although we appreciate their work very much, based on the in-depth analysis of this research, we found some detailed problems in the article and will give our comments in this letter. If the author can further improve the relevant research, it will be valuable. Keywords: Faecal incontinence, Manometry, Diagnostic, Pathophysiology, Tools To the editor I recently read with great interest the article "Diagnostic approach to faecal incontinence: What test and when to perform?" by Sbeit et al [1]. In this review, the author has systematically summarized and analyzed the clinical evaluation and examination of faecal incontinence (FI) patients for clinicians, which provided an important practical toolbox when evaluating FI patients. While harvesting, through further research and analysis, we found some details, looking forward to evaluation and discussion with the authors. First of all, this review focused on the etiology, pathophysiology, and clinical diagnosis of patients with FI, including high-resolution anorectal manometry (HRAM), transrectal ultrasound (TRUS), perineal ultrasound, Internal pelvic floor magnetic resonance imaging (MRI), and anal sphincter electromyography (EMG) and other neurological studies. However, the drawback is that the first step for FI patients is to use standardized and validated scoring and quality of life tools to define the severity and impact of faecal incontinence [2,3]. Yet, this most important step was not elaborated on in this review. For example, the PERFECT system of the modified OXFORD scale can be used to evaluate each vagina and/or each rectal resection. In this review, the authors concluded that the prevalence of FI in men and women is similar, and the pathogenesis is often different between men and women. In this regard, we have checked the relevant literature and reached inconsistent conclusions. A telephone survey in the United States reported a prevalence of 2.2% with a female to male ratio of 63% vs 37%, whereby 30% of the affected interviewees were older than 65 years [4]. Therefore, we believe that women may be more prone to fecal incontinence due to physiological structure and fertility reasons [5]. Besides, the etiology of FI is different in men and women. Anorectal sensory disorders are more common in men. On the other hand, women are more likely to be affected by anal sphincter disease due to obstetrical trauma and reduced PFM [6]. After intensive reading of the causes and risk factors for FI listed by the author, we found that some factors were not listed by the author, and these factors have become increasingly prominent as the incidence of female gynecological and rectal tumors increases. For example, after previous rectal surgery (such as LAR), pelvic radiotherapy, or the presence of tumors, stenosis, or persistent inflammation of the rectal wall (IBD, abscess, etc.), it is common to see impaired reservoir function, reduced size and compliance [3]. Therefore, we believe that the above factors should be added. Last but not least, the author showcases important diagnostic tools or strategies for FI patients. However, after reading lots of relevant literature, we believe that these strategies are not comprehensive enough. Since the introduction of nerve stimulation, in recent years, more and more authors have suggested skipping the basic test, and if there are no contraindications, it is recommended to try placing NS nerve stimulation (SNS) electrodes as the first step in diagnosis and treatment [7,8]. In 2012, Cochrane reviewed 21 studies with a total of 1,525 participants. It was found that limited trials could not provide sufficient evidence for the effectiveness of anal sphincter movement and biofeedback therapy. Therefore, it is recommended to combine biofeedback and/or PFMT with Other methods (such as electrical nerve stimulation combined with technology) that can enhance the overall effect [9]. Overall, this review can provide a good reference and basis for clinicians to formulate examination strategies for patients with FI, and has a certain practical value. Our comments are only based on a summary analysis of existing data, and we hope that more comprehensive and authoritative diagnosis and treatment guidelines can be applied to benefit patients with FI. References 1 Sbeit W, Khoury T, Mari A. Diagnostic approach to faecal incontinence: What test and when to perform? World J Gastroenterol 27(15): 1553-1562, doi: 10.3748/wjg.v27.i15.1553(2021). 2 Vaizey, C. J., Carapeti, E., Cahill, J. A. et al. Prospective comparison of faecal incontinence grading systems. Gut 44, 77-80, doi:10.1136/gut.44.1.77 (1999). 3 Saldana Ruiz, N. & Kaiser, A. M. Fecal incontinence - Challenges and solutions. World journal of gastroenterology 23, 11-24, doi:10.3748/wjg.v23.i1.11 (2017). 4 Nelson, R., Norton, N., Cautley, E. et al. Community-based prevalence of anal incontinence. Jama 274, 559-561 (1995). 5 Kumar, N. & Kumar, D. Fecal incontinence and rectal prolapse. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 38, 465-469, doi:10.1007/s12664-020-01014-1 (2019). 6 Mazur-Bialy, A. I., Kołomańska-Bogucka, D., Opławski, M. et al. Physiotherapy for Prevention and Treatment of Fecal Incontinence in Women-Systematic Review of Methods. Journal of clinical medicine 9, doi:10.3390/jcm9103255 (2020). 7 Kenefick, N. J., Vaizey, C. J., Nicholls, R. J. et al. Sacral nerve stimulation for faecal incontinence due to systemic sclerosis. Gut 51, 881-883, doi:10.1136/gut.51.6.881 (2002). 8 Maeda, Y., O'Connell, P. R., Lehur, P. A. et al. Sacral nerve stimulation for faecal incontinence and constipation: a European consensus statement. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 17, O74-87, doi:10.1111/codi.12905 (2015). 9 Norton, C., Chelvanayagam, S., Wilson-Barnett, J. et al. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 125, 1320-1329, doi:10.1016/j.gastro.2003.09.039 (2003).

Firstly, thank you very much for your professional comments on the article published in World Journal of Gastroenterology. Secondly, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor, and submit it online to World Journal of Gastroenterology at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for Letter to the Editor. The article processing charge will be exempted for Letter to the Editor. The Letter to the Editor will be published online after peer review. The guidelines for Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor to promote academic communication and lead the development of this discipline.

05772920

April 21, 2021, 09:48

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

It is a brief papaer on the diagnostic pathway of fecal incontinence. The work is clearly concise and of practical utility for those who approach the diagnosis of this pathology.

Thank you very much for your comments.