Title: Extremity risk factors of sepsis for gastrointestinal endoscopy in patients with liver
cirrhosis
Version: 2 Date: 28 Oct 2021
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS:
The study has many limitations that was mentioned  by the author.
There are points that need clarification in the study design.
Discussion is well written
REQUESTED REVISIONS:
Dear respectable author, I have enquiries about this manuscript:
- on what base prophylactic antibiotic was prescribed for 41 patients in experience phase? do
these patients have a specific risk factor for which antibiotic was prescribed?
- patients with HH has significantly higher sepsis rates as your results showed. also, patients
with manifest ascites do. on what base the decision was take to drain pleural effusion and not
ascites? taking into consideration that no local infection occured in pleural fluid.
- all over the years of the study, are there any changes in the protocol and machines for
disinfection of endoscopies?
-minor comments:
1. the title of the manuscript should be clear ""e.g. Risk factors of sepsis following GI endoscopy
in patients waiting for LT or before liver transplantation""
2. the background in abstract section need to be re-written to focus on the study topic.
3. line 37 add gastrointestinal endoscopy instead of endoscopy
4. line 46: and use of antibiotic prophylaxis instead of antibiotic prophylaxis.
5. line 85 to 88: is this a personal experience or case report? add reference if any. Personal
experience is not accepted in research work.
6. line 136-139: not related to the topic.
7. line 166: the doctors on duty were informed, better to be deleted.
8. line 172: and prophylactic cephalosporin was  given to all liver-transplant candidates. clarify
that antibiotics are given before endoscopy.
9. line 189:  because  they underwent emergency endoscopic hemostasis for acute GI bleeding.
better to be rephrased: causes of exclusion were: ....
10. line 237: One of them had tachycardia and low-grade fever before endoscopy. why this
patient is not excluded from the study?
11. in discussion: Moreover, when analyzing the cause of mortality in the same group of patients,
sepsis was the most common etiology  (37%) [14]. this sentence needs rephrase as it appears
as if it is your result.
12.line 320: Thus, drainage of HH and early LT are recommended to prevent complication.
needs reference.
13. line 336: ""with previous the study,"" the previous study
14. line 372: ""was difficult in  differentiate "" to differentiate."
Title: Extremity risk factors of sepsis for gastrointestinal endoscopy in patients with liver
cirrhosis
Version: 2 Date: 28 Oct 2021
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS:
The study has many limitations that was mentioned  by the author.
There are points that need clarification in the study design.
Discussion is well written
REQUESTED REVISIONS:
Dear respectable author, I have enquiries about this manuscript:
- on what base prophylactic antibiotic was prescribed for 41 patients in experience phase? do
these patients have a specific risk factor for which antibiotic was prescribed?
- patients with HH has significantly higher sepsis rates as your results showed. also, patients
with manifest ascites do. on what base the decision was take to drain pleural effusion and not
ascites? taking into consideration that no local infection occured in pleural fluid.
- all over the years of the study, are there any changes in the protocol and machines for
disinfection of endoscopies?
-minor comments:
1. the title of the manuscript should be clear ""e.g. Risk factors of sepsis following GI endoscopy
in patients waiting for LT or before liver transplantation""
2. the background in abstract section need to be re-written to focus on the study topic.
3. line 37 add gastrointestinal endoscopy instead of endoscopy
4. line 46: and use of antibiotic prophylaxis instead of antibiotic prophylaxis.
5. line 85 to 88: is this a personal experience or case report? add reference if any. Personal
experience is not accepted in research work.
6. line 136-139: not related to the topic.
7. line 166: the doctors on duty were informed, better to be deleted.
8. line 172: and prophylactic cephalosporin was  given to all liver-transplant candidates. clarify
that antibiotics are given before endoscopy.
9. line 189:  because  they underwent emergency endoscopic hemostasis for acute GI bleeding.
better to be rephrased: causes of exclusion were: ....
10. line 237: One of them had tachycardia and low-grade fever before endoscopy. why this
patient is not excluded from the study?
11. in discussion: Moreover, when analyzing the cause of mortality in the same group of patients,
sepsis was the most common etiology  (37%) [14]. this sentence needs rephrase as it appears
as if it is your result.
12.line 320: Thus, drainage of HH and early LT are recommended to prevent complication.
needs reference.
13. line 336: ""with previous the study,"" the previous study
14. line 372: ""was difficult in  differentiate "" to differentiate."
Please review this paper.
user
Title: Extremity risk factors of sepsis for gastrointestinal endoscopy in patients with liver
cirrhosis
Version: 2 Date: 28 Oct 2021
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS:
The study has many limitations that was mentioned  by the author.
There are points that need clarification in the study design.
Discussion is well written
REQUESTED REVISIONS:
Dear respectable author, I have enquiries about this manuscript:
- on what base prophylactic antibiotic was prescribed for 41 patients in experience phase? do
these patients have a specific risk factor for which antibiotic was prescribed?
- patients with HH has significantly higher sepsis rates as your results showed. also, patients
with manifest ascites do. on what base the decision was take to drain pleural effusion and not
ascites? taking into consideration that no local infection occured in pleural fluid.
- all over the years of the study, are there any changes in the protocol and machines for
disinfection of endoscopies?
-minor comments:
1. the title of the manuscript should be clear ""e.g. Risk factors of sepsis following GI endoscopy
in patients waiting for LT or before liver transplantation""
2. the background in abstract section need to be re-written to focus on the study topic.
3. line 37 add gastrointestinal endoscopy instead of endoscopy
4. line 46: and use of antibiotic prophylaxis instead of antibiotic prophylaxis.
5. line 85 to 88: is this a personal experience or case report? add reference if any. Personal
experience is not accepted in research work.
6. line 136-139: not related to the topic.
7. line 166: the doctors on duty were informed, better to be deleted.
8. line 172: and prophylactic cephalosporin was  given to all liver-transplant candidates. clarify
that antibiotics are given before endoscopy.
9. line 189:  because  they underwent emergency endoscopic hemostasis for acute GI bleeding.
better to be rephrased: causes of exclusion were: ....
10. line 237: One of them had tachycardia and low-grade fever before endoscopy. why this
patient is not excluded from the study?
11. in discussion: Moreover, when analyzing the cause of mortality in the same group of patients,
sepsis was the most common etiology  (37%) [14]. this sentence needs rephrase as it appears
as if it is your result.
12.line 320: Thus, drainage of HH and early LT are recommended to prevent complication.
needs reference.
13. line 336: ""with previous the study,"" the previous study
14. line 372: ""was difficult in  differentiate "" to differentiate."
assistant