Comments on: Colonoscopy at a tertiary health-care facility in Southwest Nigeria - spectrum of indications and colonic abnormalities.

Sir,

I have read the paper by Akere et al. regarding 250 colonoscopy cases at a tertiary hospital with great interest.[1] I would like to extend my thanks to the authors for nice analysis and graphically illustrated data. However, I have several comments on this paper.

First Comment

In this patient series, the authors showed the diagnostic yield to be 74%; abnormalities were detected in 185 patients which is graphically illustrated in Figure 1. However, later while analyzing the number of abnormalities, the authors stated that one abnormality was detected in 203 patients (81.2%), two abnormalities in 44, and three abnormalities in 3 patients (nicely demonstrated in the histogram in Figure 2). In this case, it turns out that all 250 patients had at least one abnormality. Of course, this could be a mechanical error. Anyway, this is subject to correction.

Second Comment

The authors stated that the indication in 85 patients (34%) was hematochezia, which is graphically illustrated in Table 2. However, later while analyzing those patients with hematochezia, the total number of patients with this condition turns out to be at least 102 (“hemorrhoids in 36 [31%], diverticulosis in 34 [29.3%], colorectal tumor in 16 [13.8%], and colonic polyps also in 16 [13.8%] patients”). Of course, one could imagine that there were some patients with more than one finding. However, the pie chart in Figure 3 clearly illustrates that all these patients with hematochezia had only one detected abnormality. This could also be a mechanical mistake. However, I believe such discrepancies should have been avoided.

Third Comment

There are also some unclear issues which, I believe, are also very important for surgeons, gastroenterologists, endoscopists, and other specialists. Surely, it would be very nice to mention the colonoscopy completion rate (cecal intubation) in this series because from previous studies we know the completion rate to be at about 83% in symptomatic patients[2] and up to 95% for elective colonoscopy.[3] Another question is whether or not there were any complications (either early or late).

To conclude, the paper is an interesting study, at least for surgeons, gastroenterologists, and endoscopists. It would be nice of authors to clarify the addressed issues.

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Conflicts of interest

There are no conflicts of interest.