Title: Role of Liver Transient Elastography in Detecting Cirrhosis with Esophageal and Gastric
Varices and Evaluating Variceal Severity
Version: 1 Date: 10 Apr 2025
Reviewer's report:
Main comments:
1. There is only one author in this study, which is a bit incredible. Are there any other people
involved in this work? If so, it is recommended to add them to the list of authors or add the
acknowledgments.
2. In this study, a total of 136 patients were included, of which 25 had severe EGV. The number
of cases is small and the proportion is unbalanced.
3. Many tables in the manuscript are not standardized, please revise them.
Minor comments:
1. Introduction, first paragraph: Research reported an extremely high mortality rate (up to 25%)
of a first variceal bleed in cirrhotic patients. Please add citations.
2. Introduction: It should be supplemented to explain the necessity of confirming the presence
or absence of varicose veins in patients with cirrhosis and distinguishing different degrees of
varicose veins. Please explain in detail what are the specific differences in their treatment and
prognosis.
3. Methods, first paragraph: How was the control group determined? Is it in accordance with
randomization? Please compare with the cirrhotic patients without esophageal varices.
4. Methods Table 1: The table format is not standardized, the abbreviations need to be explained,
and the statistical methods for measurement data and counting data are not reasonable.
5. Results Table 2: There is no significant difference in laboratory indicators between the healthy
control group and the cirrhosis groups. Please explain the reason.
6. Results Table 3: What is the significance of including IgG and IgM for comparison? Please
explain the reason.
7. Results Table 4: The inner diameter of the portal vein in the normal control group is 14mm?
It seems too large. Please explain the reason.
8. Results Table 5: TE threshold 6.46kPa (compared with the citation in the discussion, the
threshold is 19.2kPa)? The threshold of this study is too low. Please explain the reason.
9. Results Table 6: There is a problem with the selection of the cut-off of mild EGV. The AUC
of moderate EGV is low. The cut-off of mild EGV is larger than the moderate. Please explain
the reason.
10. Results Table 6 and Figure 2: The p value of moderate EGV is inconsistent in the chart.
11. Results: The accuracy of other non-invasive indicators in assessing varicose vein
classification was not calculated and should be compared with TE.
12. Results Figure 3: The labeling is unclear. Is it the same patient? What is the degree of varicose
veins in the patient? It is better to mark the varicose veins.
13. Discussion: It is recommended to add the disadvantages of this study.
14. Discussion: The discussion is not in-depth enough and is repeated with the introduction. The
advantages and disadvantages of TE in assessing varicose veins, the comparative discussion of
TE and other diagnostic/grading methods, and whether there are differences in varicose veins
in patients with cirrhosis of different etiologies should be added.
Title: Role of Liver Transient Elastography in Detecting Cirrhosis with Esophageal and Gastric
Varices and Evaluating Variceal Severity
Version: 1 Date: 10 Apr 2025
Reviewer's report:
Main comments:
1. There is only one author in this study, which is a bit incredible. Are there any other people
involved in this work? If so, it is recommended to add them to the list of authors or add the
acknowledgments.
2. In this study, a total of 136 patients were included, of which 25 had severe EGV. The number
of cases is small and the proportion is unbalanced.
3. Many tables in the manuscript are not standardized, please revise them.
Minor comments:
1. Introduction, first paragraph: Research reported an extremely high mortality rate (up to 25%)
of a first variceal bleed in cirrhotic patients. Please add citations.
2. Introduction: It should be supplemented to explain the necessity of confirming the presence
or absence of varicose veins in patients with cirrhosis and distinguishing different degrees of
varicose veins. Please explain in detail what are the specific differences in their treatment and
prognosis.
3. Methods, first paragraph: How was the control group determined? Is it in accordance with
randomization? Please compare with the cirrhotic patients without esophageal varices.
4. Methods Table 1: The table format is not standardized, the abbreviations need to be explained,
and the statistical methods for measurement data and counting data are not reasonable.
5. Results Table 2: There is no significant difference in laboratory indicators between the healthy
control group and the cirrhosis groups. Please explain the reason.
6. Results Table 3: What is the significance of including IgG and IgM for comparison? Please
explain the reason.
7. Results Table 4: The inner diameter of the portal vein in the normal control group is 14mm?
It seems too large. Please explain the reason.
8. Results Table 5: TE threshold 6.46kPa (compared with the citation in the discussion, the
threshold is 19.2kPa)? The threshold of this study is too low. Please explain the reason.
9. Results Table 6: There is a problem with the selection of the cut-off of mild EGV. The AUC
of moderate EGV is low. The cut-off of mild EGV is larger than the moderate. Please explain
the reason.
10. Results Table 6 and Figure 2: The p value of moderate EGV is inconsistent in the chart.
11. Results: The accuracy of other non-invasive indicators in assessing varicose vein
classification was not calculated and should be compared with TE.
12. Results Figure 3: The labeling is unclear. Is it the same patient? What is the degree of varicose
veins in the patient? It is better to mark the varicose veins.
13. Discussion: It is recommended to add the disadvantages of this study.
14. Discussion: The discussion is not in-depth enough and is repeated with the introduction. The
advantages and disadvantages of TE in assessing varicose veins, the comparative discussion of
TE and other diagnostic/grading methods, and whether there are differences in varicose veins
in patients with cirrhosis of different etiologies should be added.
Please review this paper.
user
Title: Role of Liver Transient Elastography in Detecting Cirrhosis with Esophageal and Gastric
Varices and Evaluating Variceal Severity
Version: 1 Date: 10 Apr 2025
Reviewer's report:
Main comments:
1. There is only one author in this study, which is a bit incredible. Are there any other people
involved in this work? If so, it is recommended to add them to the list of authors or add the
acknowledgments.
2. In this study, a total of 136 patients were included, of which 25 had severe EGV. The number
of cases is small and the proportion is unbalanced.
3. Many tables in the manuscript are not standardized, please revise them.
Minor comments:
1. Introduction, first paragraph: Research reported an extremely high mortality rate (up to 25%)
of a first variceal bleed in cirrhotic patients. Please add citations.
2. Introduction: It should be supplemented to explain the necessity of confirming the presence
or absence of varicose veins in patients with cirrhosis and distinguishing different degrees of
varicose veins. Please explain in detail what are the specific differences in their treatment and
prognosis.
3. Methods, first paragraph: How was the control group determined? Is it in accordance with
randomization? Please compare with the cirrhotic patients without esophageal varices.
4. Methods Table 1: The table format is not standardized, the abbreviations need to be explained,
and the statistical methods for measurement data and counting data are not reasonable.
5. Results Table 2: There is no significant difference in laboratory indicators between the healthy
control group and the cirrhosis groups. Please explain the reason.
6. Results Table 3: What is the significance of including IgG and IgM for comparison? Please
explain the reason.
7. Results Table 4: The inner diameter of the portal vein in the normal control group is 14mm?
It seems too large. Please explain the reason.
8. Results Table 5: TE threshold 6.46kPa (compared with the citation in the discussion, the
threshold is 19.2kPa)? The threshold of this study is too low. Please explain the reason.
9. Results Table 6: There is a problem with the selection of the cut-off of mild EGV. The AUC
of moderate EGV is low. The cut-off of mild EGV is larger than the moderate. Please explain
the reason.
10. Results Table 6 and Figure 2: The p value of moderate EGV is inconsistent in the chart.
11. Results: The accuracy of other non-invasive indicators in assessing varicose vein
classification was not calculated and should be compared with TE.
12. Results Figure 3: The labeling is unclear. Is it the same patient? What is the degree of varicose
veins in the patient? It is better to mark the varicose veins.
13. Discussion: It is recommended to add the disadvantages of this study.
14. Discussion: The discussion is not in-depth enough and is repeated with the introduction. The
advantages and disadvantages of TE in assessing varicose veins, the comparative discussion of
TE and other diagnostic/grading methods, and whether there are differences in varicose veins
in patients with cirrhosis of different etiologies should be added.
assistant