Reviewer ’s report  
Title: Endoscopic submucosal dissection under general anesth esia for superficial esophageal 
squamous cell carcinoma is associated with better clinical outcomes  
 
Version: 0 Date: 15 Apr 2018  
 
Reviewer: Amol Bapaye  
 
Reviewer's report:  
This is an interesting manuscript discussing outcomes of a large patient database undergoing 
ESD for SESCC. The additional discussion about superiority of general anesthesia as compared 
to conscious sedation is novel. Certain points require further explanation -  
1. Background - 3rd para - lines 3 & 4 - grammatical correction required - two negatives  
2. Page 6 - para 4 - please explain the follow up protocol clearly  
3. Page 8 - complications - minor hemostasis is almost always required after an ESD 
procedure. Therefore the term - requirin g hemostatic treatment - applies to practically every 
ESD procedure in the study. The authors further state that there were no episodes of ESD 
related bleeding. Does that imply that none of the patients undergoing ESD did not need 
any hemostatic treatment during the procedure? The authors must define the term - ESD 
related bleeding in a more specific manner  
4. ESD related perforations - please mention the type of clips used for closure - full-thickness 
or otherwise  
5. Page 10 - para 3 - post ESD stricture  preventive management - please mention make and 
type of stent used; also please mention source of polyglycolic sheet  
6. Did the authors encounter any stent migrations in the group of patients who received 
prophylactic stents?  
7. Follow up is limited. Ca n the authors present a longer term follow up for at least a subset of 
patients treated earlier?  
8. The study duration is quite long, nearly 10 years. It is possible that a learning curve effect 
is responsible for some of the outcomes of this study. It wo uld be interesting if the authors 
could perform a subset analysis of outcomes of patients treated during the initial part of the 
study period versus the latter part.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, ple ase 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.  
Yes 
Are you able to assess any statistics in the manuscri pt or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written En glish  
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 reimbursem ents, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain 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 th e 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary 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 intere sts' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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 manusc ript 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://cre ativecommons.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 jour nal 
Reviewer ’s report  
Title: Endoscopic submucosal dissection under general anesth esia for superficial esophageal 
squamous cell carcinoma is associated with better clinical outcomes  
 
Version: 0 Date: 15 Apr 2018  
 
Reviewer: Amol Bapaye  
 
Reviewer's report:  
This is an interesting manuscript discussing outcomes of a large patient database undergoing 
ESD for SESCC. The additional discussion about superiority of general anesthesia as compared 
to conscious sedation is novel. Certain points require further explanation -  
1. Background - 3rd para - lines 3 & 4 - grammatical correction required - two negatives  
2. Page 6 - para 4 - please explain the follow up protocol clearly  
3. Page 8 - complications - minor hemostasis is almost always required after an ESD 
procedure. Therefore the term - requirin g hemostatic treatment - applies to practically every 
ESD procedure in the study. The authors further state that there were no episodes of ESD 
related bleeding. Does that imply that none of the patients undergoing ESD did not need 
any hemostatic treatment during the procedure? The authors must define the term - ESD 
related bleeding in a more specific manner  
4. ESD related perforations - please mention the type of clips used for closure - full-thickness 
or otherwise  
5. Page 10 - para 3 - post ESD stricture  preventive management - please mention make and 
type of stent used; also please mention source of polyglycolic sheet  
6. Did the authors encounter any stent migrations in the group of patients who received 
prophylactic stents?  
7. Follow up is limited. Ca n the authors present a longer term follow up for at least a subset of 
patients treated earlier?  
8. The study duration is quite long, nearly 10 years. It is possible that a learning curve effect 
is responsible for some of the outcomes of this study. It wo uld be interesting if the authors 
could perform a subset analysis of outcomes of patients treated during the initial part of the 
study period versus the latter part.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, ple ase 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.  
Yes 
Are you able to assess any statistics in the manuscri pt or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written En glish  
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 reimbursem ents, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain 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 th e 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary 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 intere sts' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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 manusc ript 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://cre ativecommons.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 jour nal 
Please review this paper.
user
Reviewer ’s report  
Title: Endoscopic submucosal dissection under general anesth esia for superficial esophageal 
squamous cell carcinoma is associated with better clinical outcomes  
 
Version: 0 Date: 15 Apr 2018  
 
Reviewer: Amol Bapaye  
 
Reviewer's report:  
This is an interesting manuscript discussing outcomes of a large patient database undergoing 
ESD for SESCC. The additional discussion about superiority of general anesthesia as compared 
to conscious sedation is novel. Certain points require further explanation -  
1. Background - 3rd para - lines 3 & 4 - grammatical correction required - two negatives  
2. Page 6 - para 4 - please explain the follow up protocol clearly  
3. Page 8 - complications - minor hemostasis is almost always required after an ESD 
procedure. Therefore the term - requirin g hemostatic treatment - applies to practically every 
ESD procedure in the study. The authors further state that there were no episodes of ESD 
related bleeding. Does that imply that none of the patients undergoing ESD did not need 
any hemostatic treatment during the procedure? The authors must define the term - ESD 
related bleeding in a more specific manner  
4. ESD related perforations - please mention the type of clips used for closure - full-thickness 
or otherwise  
5. Page 10 - para 3 - post ESD stricture  preventive management - please mention make and 
type of stent used; also please mention source of polyglycolic sheet  
6. Did the authors encounter any stent migrations in the group of patients who received 
prophylactic stents?  
7. Follow up is limited. Ca n the authors present a longer term follow up for at least a subset of 
patients treated earlier?  
8. The study duration is quite long, nearly 10 years. It is possible that a learning curve effect 
is responsible for some of the outcomes of this study. It wo uld be interesting if the authors 
could perform a subset analysis of outcomes of patients treated during the initial part of the 
study period versus the latter part.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, ple ase 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.  
Yes 
Are you able to assess any statistics in the manuscri pt or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written En glish  
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 reimbursem ents, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain 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 th e 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary 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 intere sts' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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 manusc ript 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://cre ativecommons.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 jour nal 
assistant