Title: Incidental detection of upper gastrointestinal epithelial neoplasia by screening endoscopy
prior to endoscopic ultrasonography in patients with pancreaticobiliary disease
Version: 1 Date: 05 Nov 2023
Reviewer:  Jun-Hyung Cho
Reviewer's report:
The major concerns about this manuscript are as below;
First, the academic background for screening esophagogastroduodenoscopy (EGD) in patients
with pancreaticobiliary disease is not sufficient. Gastric cancer development is strongly
associated with chronic H. pylori infection, leading to atrophic gastritis and intestinal
metaplasia. To date, however, there is no association between premalignant gastric condition
and pancreaticobiliary disease. I think that the protocol of this study is just opportunistic
screening when these patients are scheduled for pancreaticobiliary EUS. In patients with severe
pancreaticobiliary disease, prior EGD before EUS may be harmful due to longer sedation time
and sequential examination.
Second, I hope that manuscript title is changed to ‘Incidental finding of esophageal and gastric
neoplasia in screening endoscopy performed prior to EUS in patients with pancreaticobiliary
disease’. Two patients were diagnosed as esophageal dysplasia or cancer.
Third, patient inclusion should be described as flow chart figure in EUS and MCC groups.
Fourth, expert or non-expert in Table 1 should be defined as doctor`s experience year and number
of endoscopy examination. Gastric mucosal atrophy in Table 1 should be classified into non-
severe/severe or closed/open type according to endoscopic or pathologic findings. The patients
with severe and open type are at higher risk of gastric cancer than non-severe and closed type.
Fifth, I don`t think magnifying endoscopy (model: H260Z, H290Z) in EUS group is randomly
selected according to doctor`s preference. In magnifying endoscopy, NBI may be used more
frequently for detecting early esophageal or gastric neoplasia. Please describe the proportion of
numbers of experts and procedure time when H260Z and H290Z endoscopies were used.
Sixth, the type of endoscopy machines is different between EUS (Olympus) and MCC (Fuji)
groups. The detection rate of gastric neoplasia may be affected by endoscopy image quality and
color contrast. This  is the big issue in present study.
Seventh, alcohol drinking and smoking history should be involved in comparison between
EUS and MCC groups (Table 2). Personal habits are important for cancer development. The
detection rates are not significant (p=0.18) between two groups after propensity score matching.
Nevertheless, the authors describe the only statistical significance of p < 0.01 before propensity
score matching in the abstract.
Lastly, the proportion of patients according to eight variables should be described in Table 3.
For example, ME and non-ME are x/xxx and x/xxx in detection of gastric neoplasia.
Title: Incidental detection of upper gastrointestinal epithelial neoplasia by screening endoscopy
prior to endoscopic ultrasonography in patients with pancreaticobiliary disease
Version: 1 Date: 05 Nov 2023
Reviewer:  Jun-Hyung Cho
Reviewer's report:
The major concerns about this manuscript are as below;
First, the academic background for screening esophagogastroduodenoscopy (EGD) in patients
with pancreaticobiliary disease is not sufficient. Gastric cancer development is strongly
associated with chronic H. pylori infection, leading to atrophic gastritis and intestinal
metaplasia. To date, however, there is no association between premalignant gastric condition
and pancreaticobiliary disease. I think that the protocol of this study is just opportunistic
screening when these patients are scheduled for pancreaticobiliary EUS. In patients with severe
pancreaticobiliary disease, prior EGD before EUS may be harmful due to longer sedation time
and sequential examination.
Second, I hope that manuscript title is changed to ‘Incidental finding of esophageal and gastric
neoplasia in screening endoscopy performed prior to EUS in patients with pancreaticobiliary
disease’. Two patients were diagnosed as esophageal dysplasia or cancer.
Third, patient inclusion should be described as flow chart figure in EUS and MCC groups.
Fourth, expert or non-expert in Table 1 should be defined as doctor`s experience year and number
of endoscopy examination. Gastric mucosal atrophy in Table 1 should be classified into non-
severe/severe or closed/open type according to endoscopic or pathologic findings. The patients
with severe and open type are at higher risk of gastric cancer than non-severe and closed type.
Fifth, I don`t think magnifying endoscopy (model: H260Z, H290Z) in EUS group is randomly
selected according to doctor`s preference. In magnifying endoscopy, NBI may be used more
frequently for detecting early esophageal or gastric neoplasia. Please describe the proportion of
numbers of experts and procedure time when H260Z and H290Z endoscopies were used.
Sixth, the type of endoscopy machines is different between EUS (Olympus) and MCC (Fuji)
groups. The detection rate of gastric neoplasia may be affected by endoscopy image quality and
color contrast. This  is the big issue in present study.
Seventh, alcohol drinking and smoking history should be involved in comparison between
EUS and MCC groups (Table 2). Personal habits are important for cancer development. The
detection rates are not significant (p=0.18) between two groups after propensity score matching.
Nevertheless, the authors describe the only statistical significance of p < 0.01 before propensity
score matching in the abstract.
Lastly, the proportion of patients according to eight variables should be described in Table 3.
For example, ME and non-ME are x/xxx and x/xxx in detection of gastric neoplasia.
Please review this paper.
user
Title: Incidental detection of upper gastrointestinal epithelial neoplasia by screening endoscopy
prior to endoscopic ultrasonography in patients with pancreaticobiliary disease
Version: 1 Date: 05 Nov 2023
Reviewer:  Jun-Hyung Cho
Reviewer's report:
The major concerns about this manuscript are as below;
First, the academic background for screening esophagogastroduodenoscopy (EGD) in patients
with pancreaticobiliary disease is not sufficient. Gastric cancer development is strongly
associated with chronic H. pylori infection, leading to atrophic gastritis and intestinal
metaplasia. To date, however, there is no association between premalignant gastric condition
and pancreaticobiliary disease. I think that the protocol of this study is just opportunistic
screening when these patients are scheduled for pancreaticobiliary EUS. In patients with severe
pancreaticobiliary disease, prior EGD before EUS may be harmful due to longer sedation time
and sequential examination.
Second, I hope that manuscript title is changed to ‘Incidental finding of esophageal and gastric
neoplasia in screening endoscopy performed prior to EUS in patients with pancreaticobiliary
disease’. Two patients were diagnosed as esophageal dysplasia or cancer.
Third, patient inclusion should be described as flow chart figure in EUS and MCC groups.
Fourth, expert or non-expert in Table 1 should be defined as doctor`s experience year and number
of endoscopy examination. Gastric mucosal atrophy in Table 1 should be classified into non-
severe/severe or closed/open type according to endoscopic or pathologic findings. The patients
with severe and open type are at higher risk of gastric cancer than non-severe and closed type.
Fifth, I don`t think magnifying endoscopy (model: H260Z, H290Z) in EUS group is randomly
selected according to doctor`s preference. In magnifying endoscopy, NBI may be used more
frequently for detecting early esophageal or gastric neoplasia. Please describe the proportion of
numbers of experts and procedure time when H260Z and H290Z endoscopies were used.
Sixth, the type of endoscopy machines is different between EUS (Olympus) and MCC (Fuji)
groups. The detection rate of gastric neoplasia may be affected by endoscopy image quality and
color contrast. This  is the big issue in present study.
Seventh, alcohol drinking and smoking history should be involved in comparison between
EUS and MCC groups (Table 2). Personal habits are important for cancer development. The
detection rates are not significant (p=0.18) between two groups after propensity score matching.
Nevertheless, the authors describe the only statistical significance of p < 0.01 before propensity
score matching in the abstract.
Lastly, the proportion of patients according to eight variables should be described in Table 3.
For example, ME and non-ME are x/xxx and x/xxx in detection of gastric neoplasia.
assistant