Title: Percutaneous Endoscopy in the Management of Intra-abdominal Complex Disorders
Version: 1 Date: 29 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Lack of Comparative Control Group
The study is a retrospective case series without a comparator (e.g., diagnostic laparoscopy,
imaging-only diagnosis).This limits the ability to objectively assess the advantages of
percutaneous endoscopy over other diagnostic modalities.
2. Small Sample Size and Single-Center Design
Only 37 patients were included, and all procedures were performed at a single center by
highly experienced endoscopists.The small sample size reduces the statistical power and
generalizability of the findings.
3. Selection Bias and Lack of Randomization
As a retrospective study, there is an inherent risk of selection bias. The patients included
may represent more diagnostically ambiguous or severe cases, which could overestimate the
effectiveness of percutaneous endoscopy.
4. Inadequate Description of Diagnostic Yield Calculation
The manuscript mentions a diagnostic accuracy rate of 91.9%, but it is unclear how this was
defined or confirmed (e.g., via pathological confirmation, clinical follow-up). Ambiguity in
outcome measurement weakens the validity of the reported success rate. Clarify the definition
of diagnostic success and specify the gold standard used for confirmation.
5. Limited Long-Term Outcome Data
The study does not report long-term follow-up data beyond the initial diagnostic and short-term
postoperative period, making it difficult to assess the technique's long-term utility and safety.
6. Underreporting of Minor Complications
The manuscript reports no postoperative complications at all, which may be an overestimation
of safety. Minor issues like transient pain, subcutaneous emphysema, or mild infections may
have been missed or underreported.
7. Cost Analysis Is Superficial
Although median hospitalization costs are provided, the economic evaluation lacks depth (e.g.,
no cost-effectiveness or cost-comparison analysis with other techniques). The value proposition
of percutaneous endoscopy remains unclear.
8. Typographical and Formatting Issues
Examples:
"Inclusion Criteria: 1) Strong suspicion..." # incomplete numbering.
Several punctuation inconsistencies (e.g., spaces before/after hyphens, commas).
9. Limited Discussion on Learning Curve
The manuscript mentions a reduction in procedure time with experience but does not analyze the
learning curve quantitatively. It is unclear how quickly new operators can become proficient.
Include data or discussion on procedural training, operator variability, or the number of cases
required to achieve competence.
10. Generalizability Is Not Adequately Addressed
All procedures were performed under specific institutional settings and by senior clinicians,
limiting reproducibility in less-equipped or rural centers. May not reflect real-world feasibility.
Title: Percutaneous Endoscopy in the Management of Intra-abdominal Complex Disorders
Version: 1 Date: 29 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Lack of Comparative Control Group
The study is a retrospective case series without a comparator (e.g., diagnostic laparoscopy,
imaging-only diagnosis).This limits the ability to objectively assess the advantages of
percutaneous endoscopy over other diagnostic modalities.
2. Small Sample Size and Single-Center Design
Only 37 patients were included, and all procedures were performed at a single center by
highly experienced endoscopists.The small sample size reduces the statistical power and
generalizability of the findings.
3. Selection Bias and Lack of Randomization
As a retrospective study, there is an inherent risk of selection bias. The patients included
may represent more diagnostically ambiguous or severe cases, which could overestimate the
effectiveness of percutaneous endoscopy.
4. Inadequate Description of Diagnostic Yield Calculation
The manuscript mentions a diagnostic accuracy rate of 91.9%, but it is unclear how this was
defined or confirmed (e.g., via pathological confirmation, clinical follow-up). Ambiguity in
outcome measurement weakens the validity of the reported success rate. Clarify the definition
of diagnostic success and specify the gold standard used for confirmation.
5. Limited Long-Term Outcome Data
The study does not report long-term follow-up data beyond the initial diagnostic and short-term
postoperative period, making it difficult to assess the technique's long-term utility and safety.
6. Underreporting of Minor Complications
The manuscript reports no postoperative complications at all, which may be an overestimation
of safety. Minor issues like transient pain, subcutaneous emphysema, or mild infections may
have been missed or underreported.
7. Cost Analysis Is Superficial
Although median hospitalization costs are provided, the economic evaluation lacks depth (e.g.,
no cost-effectiveness or cost-comparison analysis with other techniques). The value proposition
of percutaneous endoscopy remains unclear.
8. Typographical and Formatting Issues
Examples:
"Inclusion Criteria: 1) Strong suspicion..." # incomplete numbering.
Several punctuation inconsistencies (e.g., spaces before/after hyphens, commas).
9. Limited Discussion on Learning Curve
The manuscript mentions a reduction in procedure time with experience but does not analyze the
learning curve quantitatively. It is unclear how quickly new operators can become proficient.
Include data or discussion on procedural training, operator variability, or the number of cases
required to achieve competence.
10. Generalizability Is Not Adequately Addressed
All procedures were performed under specific institutional settings and by senior clinicians,
limiting reproducibility in less-equipped or rural centers. May not reflect real-world feasibility.
Please review this paper.
user
Title: Percutaneous Endoscopy in the Management of Intra-abdominal Complex Disorders
Version: 1 Date: 29 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Lack of Comparative Control Group
The study is a retrospective case series without a comparator (e.g., diagnostic laparoscopy,
imaging-only diagnosis).This limits the ability to objectively assess the advantages of
percutaneous endoscopy over other diagnostic modalities.
2. Small Sample Size and Single-Center Design
Only 37 patients were included, and all procedures were performed at a single center by
highly experienced endoscopists.The small sample size reduces the statistical power and
generalizability of the findings.
3. Selection Bias and Lack of Randomization
As a retrospective study, there is an inherent risk of selection bias. The patients included
may represent more diagnostically ambiguous or severe cases, which could overestimate the
effectiveness of percutaneous endoscopy.
4. Inadequate Description of Diagnostic Yield Calculation
The manuscript mentions a diagnostic accuracy rate of 91.9%, but it is unclear how this was
defined or confirmed (e.g., via pathological confirmation, clinical follow-up). Ambiguity in
outcome measurement weakens the validity of the reported success rate. Clarify the definition
of diagnostic success and specify the gold standard used for confirmation.
5. Limited Long-Term Outcome Data
The study does not report long-term follow-up data beyond the initial diagnostic and short-term
postoperative period, making it difficult to assess the technique's long-term utility and safety.
6. Underreporting of Minor Complications
The manuscript reports no postoperative complications at all, which may be an overestimation
of safety. Minor issues like transient pain, subcutaneous emphysema, or mild infections may
have been missed or underreported.
7. Cost Analysis Is Superficial
Although median hospitalization costs are provided, the economic evaluation lacks depth (e.g.,
no cost-effectiveness or cost-comparison analysis with other techniques). The value proposition
of percutaneous endoscopy remains unclear.
8. Typographical and Formatting Issues
Examples:
"Inclusion Criteria: 1) Strong suspicion..." # incomplete numbering.
Several punctuation inconsistencies (e.g., spaces before/after hyphens, commas).
9. Limited Discussion on Learning Curve
The manuscript mentions a reduction in procedure time with experience but does not analyze the
learning curve quantitatively. It is unclear how quickly new operators can become proficient.
Include data or discussion on procedural training, operator variability, or the number of cases
required to achieve competence.
10. Generalizability Is Not Adequately Addressed
All procedures were performed under specific institutional settings and by senior clinicians,
limiting reproducibility in less-equipped or rural centers. May not reflect real-world feasibility.
assistant