Title: Impact of obesity in colorectal endoscopic submucosal dissection: single-center
retrospective cohort study
Version: 2 Date: 26 Nov 2020
Reviewer's report:
The authors retrospectively reviewed the different outcomes of colorectal ESD among obese
and non-obese Japanese patients in the manuscript entitled, “Impact of obesity in colorectal
endoscopic submucosal dissection: a single-center retrospective cohort study”. The number of
participants was reasonable for comparison and plentiful parameters have been shown. The
major two findings were; hypoxemia which resulted in less amount of sedative drug usage
was observed in obesity and ESD in obese patients by trainees required longer procedure time.
However, a number of issues need to be addressed before this paper can potentially be accepted
for publication.
1. The two major points of ESD difficulty have been missed in this report; the degree of
submucosal fibrosis and the scope maneuverability which might affect the procedure time
difference in the group of obesity performed by trainees. Authors should demonstrate these
factors before making a conclusion. If the data was not available, these limitations should be
mentioned.
2. One of the factors, especially in the West, being concerned about undergoing ESD in obese
patients is the rotation or changing of patient position. Even though the degree of obesity in this
study was not severe, the authors should consider mentioning this concern in the discussion.
3. Another point that I feel surprised about is the very high success rate in ESD performed by
trainees. The process of supervision or takeover of the scope by an expert was not mentioned
in the Methods
4. The authors should demonstrate the difference in the degree of fatty tissue in the submucosa
among obese and non-obese patients. This factor might be the most important issue to explain
longer procedure time in the obese group.
5. The data demonstrated in the Table should be more concise. Tables 1 and 2 and the tables
5 and 6 can be incorporated.
6. The overall English language should be rewritten by a native speaker.
I hope these suggestions will help to improve this manuscript.
Title: Impact of obesity in colorectal endoscopic submucosal dissection: single-center
retrospective cohort study
Version: 2 Date: 26 Nov 2020
Reviewer's report:
The authors retrospectively reviewed the different outcomes of colorectal ESD among obese
and non-obese Japanese patients in the manuscript entitled, “Impact of obesity in colorectal
endoscopic submucosal dissection: a single-center retrospective cohort study”. The number of
participants was reasonable for comparison and plentiful parameters have been shown. The
major two findings were; hypoxemia which resulted in less amount of sedative drug usage
was observed in obesity and ESD in obese patients by trainees required longer procedure time.
However, a number of issues need to be addressed before this paper can potentially be accepted
for publication.
1. The two major points of ESD difficulty have been missed in this report; the degree of
submucosal fibrosis and the scope maneuverability which might affect the procedure time
difference in the group of obesity performed by trainees. Authors should demonstrate these
factors before making a conclusion. If the data was not available, these limitations should be
mentioned.
2. One of the factors, especially in the West, being concerned about undergoing ESD in obese
patients is the rotation or changing of patient position. Even though the degree of obesity in this
study was not severe, the authors should consider mentioning this concern in the discussion.
3. Another point that I feel surprised about is the very high success rate in ESD performed by
trainees. The process of supervision or takeover of the scope by an expert was not mentioned
in the Methods
4. The authors should demonstrate the difference in the degree of fatty tissue in the submucosa
among obese and non-obese patients. This factor might be the most important issue to explain
longer procedure time in the obese group.
5. The data demonstrated in the Table should be more concise. Tables 1 and 2 and the tables
5 and 6 can be incorporated.
6. The overall English language should be rewritten by a native speaker.
I hope these suggestions will help to improve this manuscript.
Please review this paper.
user
Title: Impact of obesity in colorectal endoscopic submucosal dissection: single-center
retrospective cohort study
Version: 2 Date: 26 Nov 2020
Reviewer's report:
The authors retrospectively reviewed the different outcomes of colorectal ESD among obese
and non-obese Japanese patients in the manuscript entitled, “Impact of obesity in colorectal
endoscopic submucosal dissection: a single-center retrospective cohort study”. The number of
participants was reasonable for comparison and plentiful parameters have been shown. The
major two findings were; hypoxemia which resulted in less amount of sedative drug usage
was observed in obesity and ESD in obese patients by trainees required longer procedure time.
However, a number of issues need to be addressed before this paper can potentially be accepted
for publication.
1. The two major points of ESD difficulty have been missed in this report; the degree of
submucosal fibrosis and the scope maneuverability which might affect the procedure time
difference in the group of obesity performed by trainees. Authors should demonstrate these
factors before making a conclusion. If the data was not available, these limitations should be
mentioned.
2. One of the factors, especially in the West, being concerned about undergoing ESD in obese
patients is the rotation or changing of patient position. Even though the degree of obesity in this
study was not severe, the authors should consider mentioning this concern in the discussion.
3. Another point that I feel surprised about is the very high success rate in ESD performed by
trainees. The process of supervision or takeover of the scope by an expert was not mentioned
in the Methods
4. The authors should demonstrate the difference in the degree of fatty tissue in the submucosa
among obese and non-obese patients. This factor might be the most important issue to explain
longer procedure time in the obese group.
5. The data demonstrated in the Table should be more concise. Tables 1 and 2 and the tables
5 and 6 can be incorporated.
6. The overall English language should be rewritten by a native speaker.
I hope these suggestions will help to improve this manuscript.
assistant