Title: Impact of timing of endoscopy on clinical outcomes in cirrhotic patients with esophageal
variceal bleeding: a monocentric retrospective study from Vietnam
Version: 2 Date: 18 Apr 2025
Reviewer's report:
This study addresses an important clinical question regarding the optimal timing of endoscopy
in cirrhotic patients with EVB. Below is my review and recommendations for improvement:
Strengths#
Clinical Relevance: The study tackles a guideline-controversial issue with practical implications
for resource allocation and emergency care pathways.
Methodology:Use of propensity score matching (PSM) to address baseline confounders.Clear
definition of primary (5-day treatment failure) and secondary outcomes (mortality, ICU needs,
etc.).
Multivariate Analysis: Identifies independent predictors of mortality (e.g., Child-Pugh score),
aligning with established prognostic factors in cirrhosis.
Major Concerns
There have been similar reports recently, so this article lacks originality (Ref: Peng M, Bai
Z, Zou D, et al. Timing of endoscopy in patients with cirrhosis and acute variceal bleeding:
a single-center retrospective study. BMC Gastroenterol. 2023;23(1):219. Published 2023
Jun 26. doi:10.1186/s12876-023-02766-8).We suggest that the author conduct a prospective
randomized controlled study to provide high-level evidence.
Sample Size and Power:
No power calculation is provided. With a 1% absolute difference in 5-day treatment failure
(10.1% vs. 9%), the study may be underpowered to detect clinically meaningful differences. A
post-hoc power analysis is recommended.
Confounding Factors:
Key variables affecting outcomes in EVB (e.g., use of vasoactive drugs, antibiotics, or
resuscitation protocols) are not described. Differences in medical management between groups
could bias results.
Endoscopist expertise and technical variability (e.g., band ligation technique) are unaddressed.
Definition of "Timing":
The time from "admission" to endoscopy is used, but guidelines typically recommend timing
from "hematemesis" or "clinical presentation." Delays in hospital transfer or triage may
confound results.
Retrospective Design Limitations:
Selection bias (e.g., sicker patients may have received earlier endoscopy) is incompletely
mitigated by PSM. Unmeasured confounders (e.g., portal pressure, collateral circulation) remain
a concern.
Conclusion:reject.
Title: Impact of timing of endoscopy on clinical outcomes in cirrhotic patients with esophageal
variceal bleeding: a monocentric retrospective study from Vietnam
Version: 2 Date: 18 Apr 2025
Reviewer's report:
This study addresses an important clinical question regarding the optimal timing of endoscopy
in cirrhotic patients with EVB. Below is my review and recommendations for improvement:
Strengths#
Clinical Relevance: The study tackles a guideline-controversial issue with practical implications
for resource allocation and emergency care pathways.
Methodology:Use of propensity score matching (PSM) to address baseline confounders.Clear
definition of primary (5-day treatment failure) and secondary outcomes (mortality, ICU needs,
etc.).
Multivariate Analysis: Identifies independent predictors of mortality (e.g., Child-Pugh score),
aligning with established prognostic factors in cirrhosis.
Major Concerns
There have been similar reports recently, so this article lacks originality (Ref: Peng M, Bai
Z, Zou D, et al. Timing of endoscopy in patients with cirrhosis and acute variceal bleeding:
a single-center retrospective study. BMC Gastroenterol. 2023;23(1):219. Published 2023
Jun 26. doi:10.1186/s12876-023-02766-8).We suggest that the author conduct a prospective
randomized controlled study to provide high-level evidence.
Sample Size and Power:
No power calculation is provided. With a 1% absolute difference in 5-day treatment failure
(10.1% vs. 9%), the study may be underpowered to detect clinically meaningful differences. A
post-hoc power analysis is recommended.
Confounding Factors:
Key variables affecting outcomes in EVB (e.g., use of vasoactive drugs, antibiotics, or
resuscitation protocols) are not described. Differences in medical management between groups
could bias results.
Endoscopist expertise and technical variability (e.g., band ligation technique) are unaddressed.
Definition of "Timing":
The time from "admission" to endoscopy is used, but guidelines typically recommend timing
from "hematemesis" or "clinical presentation." Delays in hospital transfer or triage may
confound results.
Retrospective Design Limitations:
Selection bias (e.g., sicker patients may have received earlier endoscopy) is incompletely
mitigated by PSM. Unmeasured confounders (e.g., portal pressure, collateral circulation) remain
a concern.
Conclusion:reject.
Please review this paper.
user
Title: Impact of timing of endoscopy on clinical outcomes in cirrhotic patients with esophageal
variceal bleeding: a monocentric retrospective study from Vietnam
Version: 2 Date: 18 Apr 2025
Reviewer's report:
This study addresses an important clinical question regarding the optimal timing of endoscopy
in cirrhotic patients with EVB. Below is my review and recommendations for improvement:
Strengths#
Clinical Relevance: The study tackles a guideline-controversial issue with practical implications
for resource allocation and emergency care pathways.
Methodology:Use of propensity score matching (PSM) to address baseline confounders.Clear
definition of primary (5-day treatment failure) and secondary outcomes (mortality, ICU needs,
etc.).
Multivariate Analysis: Identifies independent predictors of mortality (e.g., Child-Pugh score),
aligning with established prognostic factors in cirrhosis.
Major Concerns
There have been similar reports recently, so this article lacks originality (Ref: Peng M, Bai
Z, Zou D, et al. Timing of endoscopy in patients with cirrhosis and acute variceal bleeding:
a single-center retrospective study. BMC Gastroenterol. 2023;23(1):219. Published 2023
Jun 26. doi:10.1186/s12876-023-02766-8).We suggest that the author conduct a prospective
randomized controlled study to provide high-level evidence.
Sample Size and Power:
No power calculation is provided. With a 1% absolute difference in 5-day treatment failure
(10.1% vs. 9%), the study may be underpowered to detect clinically meaningful differences. A
post-hoc power analysis is recommended.
Confounding Factors:
Key variables affecting outcomes in EVB (e.g., use of vasoactive drugs, antibiotics, or
resuscitation protocols) are not described. Differences in medical management between groups
could bias results.
Endoscopist expertise and technical variability (e.g., band ligation technique) are unaddressed.
Definition of "Timing":
The time from "admission" to endoscopy is used, but guidelines typically recommend timing
from "hematemesis" or "clinical presentation." Delays in hospital transfer or triage may
confound results.
Retrospective Design Limitations:
Selection bias (e.g., sicker patients may have received earlier endoscopy) is incompletely
mitigated by PSM. Unmeasured confounders (e.g., portal pressure, collateral circulation) remain
a concern.
Conclusion:reject.
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