Title: Optimal Endoscopy Timing in Elderly Patients Presenting with Acute Non-Variceal
Upper Gastrointestinal Bleeding.
Version: 11 Date: 07 Oct 2024
Reviewer's report:
The manuscript addresses the timing of endoscopy in the elderly patients with nonvariceal upper
gastrointestinal bleeding (NVUGIB) and recommends that early endoscopy may benefit the
management of acute UGIB, especially in the elderly population with high comorbidities and
the severity of bleeding.
Major Comments
1. The single-center retrospective methodology significantly limits the generalizability of the
findings. The manuscript's conclusions may not apply to broader populations, which should be
addressed with multicenter trials.
2. The omission of H. pylori status, a key factor in peptic ulcer disease, undermines the study’s
thoroughness. This limitation hinders the ability to fully evaluate the etiology of UGIB in elderly
patients.
3. The manuscript inadequately incorporates modern risk stratification tools (e.g., Glasgow-
Blatchford Score) for guiding clinical decision-making. The limited discussion on the use of
these scoring systems weakens the study’s relevance in clinical practice.
4. The broad endoscopy time categories (very early, early, late) lack the nuance found in
other studies, which define more precise intervals (e.g., 6-12 hours). This could lead to missed
opportunities in refining optimal timing for interventions in different patient subgroups.
5. The manuscript does not provide adequate information regarding fluid resuscitation and
transfusion protocols. Given the heterogeneity of patients’ clinical statuses, standardizing
resuscitation approaches is crucial for assessing the true impact of endoscopy timing.
6. While it is acknowledged that very early endoscopy (<12 hours) may lead to complications
such as aspiration pneumonia and acute coronary syndrome, the manuscript fails to provide
detailed data on these adverse outcomes. This limits the ability to weigh the risks and benefits
of very early endoscopy.
7. The inclusion of patients with bleeding secondary to malignant lesions introduces potential
confounding, as these patients have inherently higher mortality rates. More robust stratification
or exclusion of these patients would enhance the validity of the findings.
8. The lack of a well-defined treatment and transfusion protocol for all patients weakens
the comparability of outcomes. Without uniform treatment measures, it becomes difficult to
attribute differences in outcomes to endoscopy timing alone.
Title: Optimal Endoscopy Timing in Elderly Patients Presenting with Acute Non-Variceal
Upper Gastrointestinal Bleeding.
Version: 11 Date: 07 Oct 2024
Reviewer's report:
The manuscript addresses the timing of endoscopy in the elderly patients with nonvariceal upper
gastrointestinal bleeding (NVUGIB) and recommends that early endoscopy may benefit the
management of acute UGIB, especially in the elderly population with high comorbidities and
the severity of bleeding.
Major Comments
1. The single-center retrospective methodology significantly limits the generalizability of the
findings. The manuscript's conclusions may not apply to broader populations, which should be
addressed with multicenter trials.
2. The omission of H. pylori status, a key factor in peptic ulcer disease, undermines the study’s
thoroughness. This limitation hinders the ability to fully evaluate the etiology of UGIB in elderly
patients.
3. The manuscript inadequately incorporates modern risk stratification tools (e.g., Glasgow-
Blatchford Score) for guiding clinical decision-making. The limited discussion on the use of
these scoring systems weakens the study’s relevance in clinical practice.
4. The broad endoscopy time categories (very early, early, late) lack the nuance found in
other studies, which define more precise intervals (e.g., 6-12 hours). This could lead to missed
opportunities in refining optimal timing for interventions in different patient subgroups.
5. The manuscript does not provide adequate information regarding fluid resuscitation and
transfusion protocols. Given the heterogeneity of patients’ clinical statuses, standardizing
resuscitation approaches is crucial for assessing the true impact of endoscopy timing.
6. While it is acknowledged that very early endoscopy (<12 hours) may lead to complications
such as aspiration pneumonia and acute coronary syndrome, the manuscript fails to provide
detailed data on these adverse outcomes. This limits the ability to weigh the risks and benefits
of very early endoscopy.
7. The inclusion of patients with bleeding secondary to malignant lesions introduces potential
confounding, as these patients have inherently higher mortality rates. More robust stratification
or exclusion of these patients would enhance the validity of the findings.
8. The lack of a well-defined treatment and transfusion protocol for all patients weakens
the comparability of outcomes. Without uniform treatment measures, it becomes difficult to
attribute differences in outcomes to endoscopy timing alone.
Please review this paper.
user
Title: Optimal Endoscopy Timing in Elderly Patients Presenting with Acute Non-Variceal
Upper Gastrointestinal Bleeding.
Version: 11 Date: 07 Oct 2024
Reviewer's report:
The manuscript addresses the timing of endoscopy in the elderly patients with nonvariceal upper
gastrointestinal bleeding (NVUGIB) and recommends that early endoscopy may benefit the
management of acute UGIB, especially in the elderly population with high comorbidities and
the severity of bleeding.
Major Comments
1. The single-center retrospective methodology significantly limits the generalizability of the
findings. The manuscript's conclusions may not apply to broader populations, which should be
addressed with multicenter trials.
2. The omission of H. pylori status, a key factor in peptic ulcer disease, undermines the study’s
thoroughness. This limitation hinders the ability to fully evaluate the etiology of UGIB in elderly
patients.
3. The manuscript inadequately incorporates modern risk stratification tools (e.g., Glasgow-
Blatchford Score) for guiding clinical decision-making. The limited discussion on the use of
these scoring systems weakens the study’s relevance in clinical practice.
4. The broad endoscopy time categories (very early, early, late) lack the nuance found in
other studies, which define more precise intervals (e.g., 6-12 hours). This could lead to missed
opportunities in refining optimal timing for interventions in different patient subgroups.
5. The manuscript does not provide adequate information regarding fluid resuscitation and
transfusion protocols. Given the heterogeneity of patients’ clinical statuses, standardizing
resuscitation approaches is crucial for assessing the true impact of endoscopy timing.
6. While it is acknowledged that very early endoscopy (<12 hours) may lead to complications
such as aspiration pneumonia and acute coronary syndrome, the manuscript fails to provide
detailed data on these adverse outcomes. This limits the ability to weigh the risks and benefits
of very early endoscopy.
7. The inclusion of patients with bleeding secondary to malignant lesions introduces potential
confounding, as these patients have inherently higher mortality rates. More robust stratification
or exclusion of these patients would enhance the validity of the findings.
8. The lack of a well-defined treatment and transfusion protocol for all patients weakens
the comparability of outcomes. Without uniform treatment measures, it becomes difficult to
attribute differences in outcomes to endoscopy timing alone.
assistant