ALL Metrics
-
Views
-
Downloads
Get PDF
Get XML
Cite
Export
Track
Research Article

Colonoscopy in patients with inflammatory bowel disease: self-reported experience, understanding, anxieties and tolerance of the procedure

[version 1; peer review: 3 approved with reservations]
PUBLISHED 30 Sep 2015
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

Abstract

Objective: To address Inflammatory Bowel Disease (IBD) patients’ attitudes, understanding and tolerance of colonoscopy and assess whether there are specific factors that influence these parameters.
Design: structured questionnaire-based survey. Tolerance of various aspects of colonoscopy procedure graded on a scale 1-5, 5 representing most intolerance/burden (worries/concerns about the procedure/risks, bowel preparation, disruption to life, procedural discomfort and travel concerns).
Setting: London teaching hospital - St Georges Hospital
Patients: Consecutive patients with established IBD attending the specialist IBD clinic
Results: 98 patients responded (46% male). Mean age was 43.2 years. 33 had Ulcerative Colitis (UC), 50 had Crohn’s Disease (CD), and 11 were unsure of diagnosis. Mean number of colonoscopies was 3.7. Females were more worried about the procedure than males (3.0 vs 2.1, p<0.05), were less tolerant of bowel preparation (3.5 vs 2.3, p<0.05), experienced more disruption to their lives (2.9 vs 1.9, p<0.05) and were more troubled by travel concerns (2.0 vs 1.4, p<0.05). Patients with the disease for ≥ 5 years experienced significantly more discomfort than patients with the disease for a shorter duration (3.2 vs 2.7 p<0.05). Patients aged ≥55 years are significantly less worried about the procedure (2.7 vs 2.0, p = <0.05) and tolerate the bowel preparation better (3.1 vs 2.4, p = <0.05). The majority of the patients felt colonoscopy was ‘bearable’ (53%) with only 13% describing it as ‘very unpleasant’. 55% would have the procedure ‘as frequently as required’ if their physician felt it appropriate.
Conclusions: Our research highlights a significant difference in the perception of colonoscopy by gender and age. Overall our findings reveal a preparedness to undergo colonoscopy as required despite an increasing requirement for this test. The differences highlighted should prompt endoscopy units to accommodate and make allowances for these different perceived tolerance in routine clinical activity.

Keywords

Inflammatory bowel disease, Colonoscopy, tolerance

Introduction

Inflammatory Bowel Disease (IBD), made up primarily of Ulcerative Colitis (UC) and Crohn’s Disease (CD), is a chronic relapsing and remitting intestinal condition that affects an estimated 240,000 patients in the UK1. Medical treatment of IBD may include combinations of steroids, 5-aminosalicylic acids (5-ASAs), immunomodulators and biologic therapies. Failure of medical therapy may lead to surgery. Optimising treatment is dependent on various surrogate markers of inflammation, radiological imaging and direct endoscopic assessment of mucosal inflammation2. More recently, the importance of mucosal healing, as determined at colonoscopy, has been underscored as a key indicator of therapeutic success2,3. Mucosal healing is associated with improved health-related quality of life4, results in a longer time to relapse in CD5, and ultimately in fewer hospital admissions6.

Non-invasive surrogate markers of inflammation such as faecal calprotectin may offer an alternative in the assessment of disease activity in IBD but are yet to be fully evaluated as an alternative to direct visualisation of mucosal healing7. Colonoscopy therefore currently remains the gold standard test for assessing mucosal healing. This potentially means an increasing burden of endoscopic procedures from the current level for IBD patients in the future8. However, colonoscopy is invasive, time consuming and costly, and may be viewed as an unpleasant or intolerable procedure by patients. With this in mind, it is important to assess patients’ perception and tolerance of colonoscopy, particularly since it may be performed increasingly more often to assess mucosal healing. We therefore aimed to assess the perceptions of a cohort of IBD patients consecutively recruited through a specialist IBD clinic at a large regional hospital with respect to their understanding, experience and attitudes towards colonoscopy.

Methods

Our study was performed at St George’s Hospital (SGH), which is a large 800 bed regional teaching hospital in central London with a catchment area of about 1.3 million patients. The department of gastroenterology runs weekly IBD specialist clinics. The endoscopy unit performs over 5000 procedures per year and is both a regional bowel cancer screening centre and national colonoscopy training centre. Colonoscopies were either performed by a senior clinician or by a trainee under their direct supervision. Consecutive patients with an established diagnosis of IBD attending the weekly specialist IBD clinic were invited to take part in this study by completing a short questionnaire. Data was collected over a 4 month period between September and December 2013. Data was collected anonymously. There was no specific exclusion criteria and the inclusion criteria was a confirmed diagnosis of IBD with a history of at least one colonoscopy. Consent was presumed by patients’ willingness to complete the survey. They were informed verbally by the clinic staff, that the data they provided would be used in a study to evaluate patients’ perceptions, understanding tolerance and experience of colonoscopy. Ethical approval was sought from the local Health Research Authority, who felt after consideration of the methodology, that specific ethical approval was not required for this study. The questionnaire comprised of nine questions and was divided into categories described below. A copy of the questionnaire in full is available as Supplementary materials.

Demographics, disease characteristics and understanding of the procedure

Patients were asked to self-report their age and sex and provide details of their IBD subtype and how long they had had their diagnosis as they understood it. They were asked to estimate how many colonoscopies they had undergone since diagnosis. Patients were also asked to demonstrate their understanding of the indications for colonoscopy. They were provided with eight potential indications, four of which are accepted indications and four which were “sham” indications. Choices available - 1) to assess how severe the disease is, 2) to see if you have constipation (sham), 3) to see if your treatment is working, 4) to see if there is another cause for your symptoms, 5) to get samples of the bowel wall (biopsies), 6) to see if you are digesting food properly (sham), 7) to get blood sample (sham), and 8) to check for intestinal worms (sham).

Experience of procedure

The patients were asked to address the burden of various aspects of the procedure using a numerical grading score 1 to 5, where 1 represents least burden and 5 most burden. Parameters evaluated included: worries/concerns about the procedure/risks, bowel preparation, disruption to life, procedural discomfort and travel to and from hospital. They were then given the opportunity to describe the entire colonoscopy experience using one of the following qualitative statements: not unpleasant, neither unpleasant nor pleasant, bearable, unpleasant, and very unpleasant.

Finally, the patients were asked to comment on how often they felt they could tolerate the procedure (once a year, once every 2 years, once every 3 years, once every 5 years, or as often as their doctor felt it appropriate). They were also given a space to add further comments about any aspect of their colonoscopy experience.

Data was collected, stored and analysed on StatView™ 5.0.1 statistics program (Abacus Corporation, Baltimore, Maryland, USA). Where appropriate, comparison of continuous data was performed using the student’s t-test.

Results

Table showing raw data collection from questionnaires
Pt No.Q1: Female 1: male 2Q2: Age (years)Q3: UC 1/CD 2/? 3Q4:How long diagnosed (code)Q5:No colonsQ6: no correctQ6iQ6iiQ6iiiQ6ivQ6vQ6viQ6viiQ6viiiQ7aQ7bQ7cQ7dQ7eQ8 (code)Q9 (code)
11242632100010002424254
22492784101110001322122
31231224101110001334132
41681784101110003554135
51351543111010002122225
625917163100110001222125
71312523101100003312232
82642784101110003534145
92661211100000002111115
102472113100110003224145
112511783101010002422332
121331653100110002322142
131492414101110003333135
142793530000001001233245
152512753101010002432132
162731723100110001122135
172691524101110001115155
181392721100000003513532
191271113100110002452135
201271311000100002522233
211242554101110004515255
222202624101110001214135
232622334101110001222115
242371541100000002225415
252432644101110001111141
262422623100110003114233
271232514101110003311115
2815217152100010005235135
292532751000101111115154
302802744101110001211125
311512412100100003333335
322491454101110003433435
331532742100010003333334
3414327104101110003424245
3514026153101010005335152
362471433100110001111125
371642644101110002113135
382661652100010001111131
392522764101110001112231
402283213100110003311131
411451631001000004333133
421562423101100003333231
431361313100110005444135
441393224101110001111111
451182424101110002311131
461232413101011102213131
471282423100111001323231
481712541000100001333145
492652422000110001212122
502362641100000002222235
512792634101110003333333
522543434101110003222235
531212522100010003545255
541351523100110002444145
551492784101110001332215
562292513101011003223135
572232622101000003535154
581213522100100004334135
591491433100110003334435
602262623100110012342125
611381233100110003333333
621402552100010004442145
632363624101110001125155
641372521100000004555545
651402533100110005555354
661413122000110003333335
671313654101110005435151
681351572100010005555542
691421624101110001334135
701431322100010005311125
711312251000100005523134
722282471100000004223332
731272454101110005555515
742522641100000003333131
751291223100110003333335
761613743100110005444254
772192211100000003445155
781542612100010003533335
792213313100110003223235
802341313100110104445145
812372744101110002213121
822353211000010004434245
832291414101110004322135
842432673100110001511112
8527527103101010003113131
862381431001000104333135
871431522100010003432223
881342344101110001411135
891701741001000103532531
901461114101110004542231
911481543100110002333135
921482631100000001155121
932432753101010001112135
Dataset 1.Table showing raw data collection from questionnaires.

94/295 patients completed the questionnaire (32% response rate). 46% were male. Mean age was 43.2 years (male 47.1 years; female 39.9 years). Table 1 presents combined demographic, disease and tolerance data on the entire cohort of responders. More than 60% of responders to the questionnaire had their disease for longer than 5 years. The most burdensome aspect of the procedure reported was bowel preparation and procedural discomfort.

Table 1. Perspective on colonoscopy in IBD patients - Whole cohort data.

Patient no.94
Male:Female (male %)43:51 (45.7%)
Mean age (yrs)43.2
UC:CD:unsure33:50:11
Length of disease
     Less than 1 year
     1 to 2 years
     2 to 3 years
     3 to 5 years
     5 to 10 years
     More than 10 years
     More than 20 years

4.3%
9.6%
7.4%
17.0%
19.1%
21.3%
21.3%
Mean no. colonoscopies3.7
% questions correct69.2%
Mean score
      Procedure worry
      Bowel preparation
      Disruption to life
      Discomfort
      Travel to hospital

2.6
3.0
2.4
3.0
1.7

All statistics corrected to 1 decimal place

Table 2 shows the intergroup comparison data. Of note, females found all aspects of colonoscopy more burdensome than their male counterparts, with all parameters reaching statistical significance bar procedural discomfort. Of interest, older patients (>55 years) reported less concerns about the procedure and associated risk, and also were less burdened by bowel preparation. Finally, patients with a longer disease duration reported higher burden of procedural discomfort.

Table 2. Intergroup comparison of demographics, disease characteristics and reported procedural burden in patients with IBD who have undergone Ileocolonoscopy.

Disease typeSexAgeLength of diseaseNo. of colonoscopies
UCCDMaleFemale< 55 years≥ 55 yearsDisease
< 5 years
Disease
≥ 5 years
< 4 colons≥ 4 colons
Patient no.33504351761836585440
UC:CD:unsureN/AN/A13:24:620:26:526:41:97:9:216:14:617:36:520:25:913:25:2
Male:Female
(male %)
13:20
(39.4%)
24:26
(48.0%)
N/AN/A31:45
(40.8%)
12:6
(66.7%)
16:20
(44.4%)
27:31
(46.6%)
36:18
(66.7%)
20:20
(50.0%)
Age (yrs)44.842.747.139.9*N/AN/A39.246.3*39.847.9*
Length of disease
     Less than 1 year
     1 to 2 years
     2 to 3 years
     3 to 5 years
     5 to 10 years
     More than 10 years
     More than 20 years

2 (6.1%)
4 (12.2%)
4 (12.2%)
6 (18.2%)
7 (21.2%)
4 (12.2%)
6 (18.2%)

1 (2.0%)
2 (4.0%)
2 (4.0%)
9 (18.0%)
9 (18.0%)
14 (28.0%)
13 (26%)

1 (2.3%)
4 (9.3%)
3 (7.0%)
8 (18.6%)
4 (9.3%)
11 (25.6%)
12 (27.9%)

3 (5.9%)
5 (9.8%)
4 (7.8%)
8 (15.7%)
14 (27.5%)
9 (17.6%)
8(15.7%)

4 (5.3%)
8 (10.5%)
6 (7.9%)
14 (18.4%)
15 (19.7%)
17 (22.4%)
12 (15.8%)

0 (0.0%)
1 (5.6 %)
1 (5.6%)
2 (11.1%)
3 (16.7%)
3 (16.7%)
8 (44.4%)
N/AN/A
4 (7.4%)
8 (14.8%)
6 (11.1%)
12 (22.2%)
11 (20.4%)
11 (20.4%)
2 (3.7%)

0 (0.0%)
1 (2.5%)
1 (2.5%)
4 (10.0%)
7 (17.5%)
9 (22.5%)
18 (45.0%)
Mean no. colonoscopies3.83.93.93.63.54.72.34.6*N/AN/A
% questions correct68.2%70.0%69.8%68.6%69.1%69.5%70.8%68.0%67.1%71.9%
Mean score
     Procedure worry
     Bowel preparation
     Disruption to life
     Discomfort
     Travel to hospital

2.6
3.0
2.7
2.9
0.8

2.5
3.0
2.3
3.1
1.7*

2.1
2.3
1.9
2.8
1.4

3.0*
3.5*
2.9*
3.1
2.0*

2.7
3.1
2.5
3.1
1.8

2.0*
2.4*
2.2
2.7
1.5

2.8
3.0
2.4
2.7
1.8

2.5
2.9
2.5
3.2*
1.7

2.6
3.0
2.6
3.1
1.7

2.6
3.0
2.3
2.9
1.8

All statistics shown to 1 DP. UC - ulcerative colitis CD - Crohn's disease *p<0.05

Patients demonstrated good knowledge in their understanding of the indications for colonoscopy, with 69.2% answering all four indications correctly. Figure 1 illustrates patient responses to the individual indications for colonoscopy. Figure 2 indicates the qualitative summary statements by IBD patients as to general tolerability of the procedure. The majority of patients thought colonoscopy was bearable (53%), with only a small minority (13%) describing it as very unpleasant. Figure 3 indicates the frequency that respondents would be prepared to tolerate colonoscopy in future. The majority of patients (55%) would have the procedure ‘as frequently as required if their physician felt it appropriate’. A very small minority (7%) responded that they would only prepared to have colonoscopy every 5 years.

f9853371-6e4f-4de0-9684-0353c9bf31f5_figure1.gif

Figure 1. Proportion of patients correctly and incorrectly choosing indications for ileocolonoscopy.

f9853371-6e4f-4de0-9684-0353c9bf31f5_figure2.gif

Figure 2. Summary statements on experience of colonoscopy in patients with IBD.

f9853371-6e4f-4de0-9684-0353c9bf31f5_figure3.gif

Figure 3. Frequency that respondents would tolerate colonoscopy.

Discussion

Main findings

Mucosal healing has evolved as a key endpoint in the assessment of therapeutic response to medical therapy in IBD patients. Requests for colonoscopy are therefore likely to continue to increase in this patient group making it particularly important to gain insight into the patients’ perceptions of this procedure. A good patient experience in the endoscopy unit is critical in facilitating long term medical management and continued engagement in services in this cohort. We have found that both women and young patients have a heightened concern about this procedure although actual reported discomfort following the procedure did not differ in these sub-groups from the rest of the cohort. Patients with an IBD disease duration of more than 5 years expressed significantly more procedural discomfort than patients with a shorter duration.

Findings in relation to other studies

Our research highlights a significant difference in the perception of colonoscopy between men and women. Females had a significantly worse perception of colonoscopy in four key areas: concerns about the procedure and associated risks; tolerance of bowel preparation; disruption to life and travel concerns to and from hospital, but not procedural discomfort itself. The results illustrate that women have higher pre-procedural anxiety than men. There are limited studies differentiating between gender and pre-procedure anxiety in patients with IBD, but our findings are supported by other work examining procedural anxiety in a non-IBD population undergoing colonoscopy9,10.

In our cohort, females showed a tendency towards increased procedural discomfort compared with males, approaching statistical significance. The majority of previous work on this subject suggests that females experience more discomfort during colonoscopy1113, although this is not a universal finding14. It has been suggested that performing colonoscopy on females may be more difficult and more uncomfortable because of previous gynaecological surgery or differing colonic and pelvic anatomy12, and of note in this respect the procedure usually takes longer in women15.

Bowel preparation in colonoscopy is another important area of patient concern, with one study suggesting it is the most unpleasant part of the whole process16. This was mirrored in our group of patients with bowel preparation perceived as the most burdensome aspect of the whole episode (joint top with procedural discomfort). In our study, women were significantly less satisfied with bowel preparation compared to men, a finding supported by others17. The negative symptoms associated with bowel preparation may magnify pre-procedural anxiety in this group of patients18.

Our results showed significant age-related differences in two measured outcomes. Patients aged 55 years or more were less worried about the procedure and risks. Secondly, this group reported that they found bowel preparation less burdensome than their younger counter parts. In keeping with our findings, a study showed older people expressed less discomfort associated with bowel preparation than younger patients and were overall, more satisfied17.

However, we did not observe differences in procedural discomfort between the two age groups. The literature in this respect is conflicting. A Finnish retrospective study reported that older patients tolerate the procedure better than younger patients9. Conversely, Kim et al. reported no significant age-related differences19. Other studies have indicated older patients may tolerate the procedure less12. These inconsistencies between studies may reflect differences in the indication for and the underlying pathologies of the respective patient groups studied. Additionally, ‘older age’ is categorized differently between studies.

Our study showed that patients who had IBD for more than 5 years expressed significantly more discomfort than patients having the disease for less than 5 years. This finding may relate to underlying disease factors, such as inflammation, stricturing or reduced intestinal compliance resulting in increased technical difficulty and reduced patient tolerance. One large study reported that higher doses of sedation are required amongst IBD patients with active disease20. An alternative explanation is that endoscopists now administer lower doses than historically in response to tighter monitoring and auditing of sedation practices. In a single centre study from the UK of sedation practices over a 10 year period sedation rates for outpatient diagnostic upper endoscopy reduced by 54%21. Certainly, in light of the 2004 NECPOD report ‘Scoping our Practice’22, sedation in all patient groups, particularly the elderly, has come under close scrutiny, and inevitably has influenced recent practice in endoscopic sedation. Kale et al. suggested endoscopy sedation should be individualised to the specific need of the IBD patient, particularly those that have active disease20 and this is clearly pertinent to the vulnerable subgroups we have identified, namely women and young patients.

The majority of our patients were prepared to undergo colonoscopy as frequently as their physician felt it appropriate. Similarly the majority also found colonoscopy ‘bearable’. These findings support the evidence that colonoscopy is generally associated with high levels of patient satisfaction and willingness to return23. This is a particularly important factor in patients with IBD, given that they are likely to undergo repeated procedures, especially when they enter into colorectal cancer surveillance programs. Our data suggests a high level of understanding of the indications of the procedure, which may further explain why most are prepared to undergo colonoscopy as frequently as needed.

Strengths and limitations

This study has some limitations, particularly since responses were obtained retrospectively which opens it up to recall bias. If the most recent colonoscopy was a negative experience, irrespective of previous positive experiences, this may have impacted adversely. In one study, a fifth of patients reported that colonoscopy was more uncomfortable than they had expected24 and a previous experience of pain during colonoscopy was found to influence the perceived experience of pain during a subsequent procedure9. We sought to evaluate the patients’ qualitative perception of colonoscopy but a more objective and validated verification of discomfort during colonoscopy (or immediately following) might have led to different conclusions. We did not assess the patients’ requirement for sedation and analgesia, which may also have later influenced patients’ perception given the recognised retrograde-amnesic effect of benzodiazepines but we feel our study design best reflects the patient experience in routine clinical practise. Finally, our questionnaire did not include questions relating to ‘procedural embarrassment’, which has been significantly linked to non-compliance in endoscopic screening programs25.

Implications and future work

Providing patients with a positive experience is clearly important in maintaining continued engagement with medical services. Our findings indicate steps need to be taken to address the particular concerns of women and young patients with IBD in advance of their procedure. How might we ameliorate perceived pre-procedural patient concerns better? Consultation prior to colonoscopy with a clinician is associated with increased patient satisfaction26. This should form part of the consent process that is ideally performed before the day of procedure and after the clinic consult, as is the practice for the national bowel cancer screening programme. However, this may not always be logistically feasible. Music during the procedure has been shown to improve procedural experience and reduce anxiety amongst women and increases wellbeing amongst men, as well as significantly reducing discomfort27,28. Similarly, continuity of endoscopist for each procedure also lowers anxiety in females29, although this approach may be difficult to adopt in NHS endoscopy units that usually have pooled waiting lists and endoscopic trainees. Reviewing previous sedation requirements and recorded pain scores should be routine endoscopic practice to individualise the sedation plan. The analgesic adjunct of inhaled Nitrous oxide, a quick acting potent analgesic and anxiolytic, may also be helpful reducing excessive intravenous sedation30. By taking all these factors into account the global patient experience can be improved.

In conclusion, our research highlights a significant difference in the perception of colonoscopy dependent on gender, age of the patient and disease duration. These results should prompt endoscopy units to improve the experience of colonoscopy particularly amongst these subgroups of patients with IBD. In the future surrogate markers such as faecal calprotectin may reduce the burden of colonoscopy. In the meantime, further research is required to develop simple clinical tools to better identify and improve the experience of vulnerable patients that would otherwise tolerate the colonoscopic experience poorly.

Data availability

F1000Research: Dataset 1. Table showing raw data collection from questionnaires, 10.5256/f1000research.6889.d10284131

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 30 Sep 2015
Comment
Author details Author details
Competing interests
Grant information
Copyright
Download
 
Export To
metrics
Views Downloads
F1000Research - -
PubMed Central
Data from PMC are received and updated monthly.
- -
Citations
CITE
how to cite this article
Morgan S, Alexakis C, Medcalf L et al. Colonoscopy in patients with inflammatory bowel disease: self-reported experience, understanding, anxieties and tolerance of the procedure [version 1; peer review: 3 approved with reservations]. F1000Research 2015, 4:927 (https://doi.org/10.12688/f1000research.6889.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.

Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 30 Sep 2015
Views
8
Cite
Reviewer Report 10 Oct 2016
Alyssa Parian, Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA 
Approved with Reservations
VIEWS 8
This is a retrospective review of 94 IBD patients at a single center evaluating the IBD patient experience of colonoscopy. The importance of colonoscopy and mucosal healing requires more frequent colonoscopic exams and determining how to make the experience as pleasant as ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Parian A. Reviewer Report For: Colonoscopy in patients with inflammatory bowel disease: self-reported experience, understanding, anxieties and tolerance of the procedure [version 1; peer review: 3 approved with reservations]. F1000Research 2015, 4:927 (https://doi.org/10.5256/f1000research.7416.r16816)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Views
10
Cite
Reviewer Report 21 Mar 2016
Agata Mulak, Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland 
Approved with Reservations
VIEWS 10
This is a single-center study assessing self-reported experience, understanding, anxiety and tolerance of colonoscopy in 94 patients with inflammatory bowel disease (IBD). The study addresses important issues and has potential practical implications as understanding patients’ experience of the procedure is ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Mulak A. Reviewer Report For: Colonoscopy in patients with inflammatory bowel disease: self-reported experience, understanding, anxieties and tolerance of the procedure [version 1; peer review: 3 approved with reservations]. F1000Research 2015, 4:927 (https://doi.org/10.5256/f1000research.7416.r12490)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Views
20
Cite
Reviewer Report 27 Jan 2016
Vassiliki Tsikitis, Department of Surgery, Oregon Health & Science University, Portland, OR, USA 
Approved with Reservations
VIEWS 20
In the article “Colonoscopy in patients with inflammatory bowel disease: self-reported experience, understanding, anxieties and tolerance of the procedure,” the authors comment that the perception of colonoscopy significantly differs by gender and age of this unique patient population, where colonoscopy ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Tsikitis V. Reviewer Report For: Colonoscopy in patients with inflammatory bowel disease: self-reported experience, understanding, anxieties and tolerance of the procedure [version 1; peer review: 3 approved with reservations]. F1000Research 2015, 4:927 (https://doi.org/10.5256/f1000research.7416.r11540)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 30 Sep 2015
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
Sign In
If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password.

The email address should be the one you originally registered with F1000.

Email address not valid, please try again

You registered with F1000 via Google, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Google account password, please click here.

You registered with F1000 via Facebook, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Facebook account password, please click here.

Code not correct, please try again
Email us for further assistance.
Server error, please try again.