Reviewer ’s report  
 
Title: The diagnostic ability of SPECT/CT fusion imaging for gastrointestinal bleeding: A 
retrospective study  
 
Version: 1 Date: 04 Oct 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER COMMENTS: To view the full report from the academic peer reviewer, 
please see the attached file.  
 
REVIEWER COMMENTS FROM REPORT: The authors have addressed a genuine area of 
certainty in clinical practice around the opt imum imaging modality for patients with GI bleeding.  
The study is well -written and referenced.  
The tables are presented clearly.  
However, given the retrospective nature of the study and the relatively small number of patients 
included, it is very difficult to make a clinically meaningful interpretation of the results 
presented.  
Use of percentages with such small numbers should be av oided, it gives a false impression of the 
degree of specificity and sensitivity.  
The authors correctly note that GI bleeding can be life threatening, but in those situations it is 
unlikely that an unstable patient would be put through further imaging and d elay definitive 
treatment, particularly for suspected lower GI bleeding where the patient just needs surgery.  
The limitations in this study are noted, but with little detail and discussion of how these might 
reduce the strength of the findings reported.  
 
REQUESTED REVISIONS:  
See above comments in the above research quality commentary. Given the smaller numbers, I 
think the paper needs to be more frank about acknowledging the limitations, and certainly more 
cautious in it's conclusions.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections  before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received  reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?   
 
2. Do you hold any stocks or shares in an organisation that may in any way gai n or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salar y from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
This reviewer has bee n recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution Licens e 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal . I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: The diagnostic ability of SPECT/CT fusion imaging for gastrointestinal bleeding: A 
retrospective study  
 
Version: 1 Date: 04 Oct 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER COMMENTS: To view the full report from the academic peer reviewer, 
please see the attached file.  
 
REVIEWER COMMENTS FROM REPORT: The authors have addressed a genuine area of 
certainty in clinical practice around the opt imum imaging modality for patients with GI bleeding.  
The study is well -written and referenced.  
The tables are presented clearly.  
However, given the retrospective nature of the study and the relatively small number of patients 
included, it is very difficult to make a clinically meaningful interpretation of the results 
presented.  
Use of percentages with such small numbers should be av oided, it gives a false impression of the 
degree of specificity and sensitivity.  
The authors correctly note that GI bleeding can be life threatening, but in those situations it is 
unlikely that an unstable patient would be put through further imaging and d elay definitive 
treatment, particularly for suspected lower GI bleeding where the patient just needs surgery.  
The limitations in this study are noted, but with little detail and discussion of how these might 
reduce the strength of the findings reported.  
 
REQUESTED REVISIONS:  
See above comments in the above research quality commentary. Given the smaller numbers, I 
think the paper needs to be more frank about acknowledging the limitations, and certainly more 
cautious in it's conclusions.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections  before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received  reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?   
 
2. Do you hold any stocks or shares in an organisation that may in any way gai n or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salar y from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
This reviewer has bee n recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution Licens e 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal . I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: The diagnostic ability of SPECT/CT fusion imaging for gastrointestinal bleeding: A 
retrospective study  
 
Version: 1 Date: 04 Oct 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER COMMENTS: To view the full report from the academic peer reviewer, 
please see the attached file.  
 
REVIEWER COMMENTS FROM REPORT: The authors have addressed a genuine area of 
certainty in clinical practice around the opt imum imaging modality for patients with GI bleeding.  
The study is well -written and referenced.  
The tables are presented clearly.  
However, given the retrospective nature of the study and the relatively small number of patients 
included, it is very difficult to make a clinically meaningful interpretation of the results 
presented.  
Use of percentages with such small numbers should be av oided, it gives a false impression of the 
degree of specificity and sensitivity.  
The authors correctly note that GI bleeding can be life threatening, but in those situations it is 
unlikely that an unstable patient would be put through further imaging and d elay definitive 
treatment, particularly for suspected lower GI bleeding where the patient just needs surgery.  
The limitations in this study are noted, but with little detail and discussion of how these might 
reduce the strength of the findings reported.  
 
REQUESTED REVISIONS:  
See above comments in the above research quality commentary. Given the smaller numbers, I 
think the paper needs to be more frank about acknowledging the limitations, and certainly more 
cautious in it's conclusions.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections  before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received  reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?   
 
2. Do you hold any stocks or shares in an organisation that may in any way gai n or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salar y from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
This reviewer has bee n recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution Licens e 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal . I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant