Title: External validation of the BEST-J score and a new risk prediction model for ESD delayed
bleeding in patients with early gastric cancer
Version: 2 Date: 05 Feb 2022
Reviewer's report:
This study is about the prediction of delayed bleeding in ESD for EGC comparing BEST-J score
and new one. I’ve read this study with great interests. This is well designed study, however,
there were some debates as follows;
Major comments
Taking apart BEST-J score, which shows modest prediction value, the significant factors for
delayed bleeding were smoking, tumor size, hemoclip use, multiple tumors and prolonged aPTT.
We can expect that patient factor, humoral factor and procedure related factors are related to a
delayed bleeding. The authors suggested smoking is related to a delayed bleeding, but there was
no sufficient explanation about this.
Second, we can agree that tumor size and multiple tumor would be associated with a delayed
bleeding, However, hemoclip use itself can’t be a significant factor, because it only reflects
intraprocedural bleeding. There are lots of method to control bleeding during procedure, so
hemoclip use means severe intraprocedural bleeding.  Thus, it is appropriate to assess the degree
of bleeding during procedure.
Third, prolonged aPTT was important factor in this study. However, this is not cause of bleeding
tendency but reflect of bleeding tendency. Again, in my knowledge, prolonged aPTT itself is
not associated with bleeding tendency. Thus, this have to be elaborated.
Title: External validation of the BEST-J score and a new risk prediction model for ESD delayed
bleeding in patients with early gastric cancer
Version: 2 Date: 05 Feb 2022
Reviewer's report:
This study is about the prediction of delayed bleeding in ESD for EGC comparing BEST-J score
and new one. I’ve read this study with great interests. This is well designed study, however,
there were some debates as follows;
Major comments
Taking apart BEST-J score, which shows modest prediction value, the significant factors for
delayed bleeding were smoking, tumor size, hemoclip use, multiple tumors and prolonged aPTT.
We can expect that patient factor, humoral factor and procedure related factors are related to a
delayed bleeding. The authors suggested smoking is related to a delayed bleeding, but there was
no sufficient explanation about this.
Second, we can agree that tumor size and multiple tumor would be associated with a delayed
bleeding, However, hemoclip use itself can’t be a significant factor, because it only reflects
intraprocedural bleeding. There are lots of method to control bleeding during procedure, so
hemoclip use means severe intraprocedural bleeding.  Thus, it is appropriate to assess the degree
of bleeding during procedure.
Third, prolonged aPTT was important factor in this study. However, this is not cause of bleeding
tendency but reflect of bleeding tendency. Again, in my knowledge, prolonged aPTT itself is
not associated with bleeding tendency. Thus, this have to be elaborated.
Please review this paper.
user
Title: External validation of the BEST-J score and a new risk prediction model for ESD delayed
bleeding in patients with early gastric cancer
Version: 2 Date: 05 Feb 2022
Reviewer's report:
This study is about the prediction of delayed bleeding in ESD for EGC comparing BEST-J score
and new one. I’ve read this study with great interests. This is well designed study, however,
there were some debates as follows;
Major comments
Taking apart BEST-J score, which shows modest prediction value, the significant factors for
delayed bleeding were smoking, tumor size, hemoclip use, multiple tumors and prolonged aPTT.
We can expect that patient factor, humoral factor and procedure related factors are related to a
delayed bleeding. The authors suggested smoking is related to a delayed bleeding, but there was
no sufficient explanation about this.
Second, we can agree that tumor size and multiple tumor would be associated with a delayed
bleeding, However, hemoclip use itself can’t be a significant factor, because it only reflects
intraprocedural bleeding. There are lots of method to control bleeding during procedure, so
hemoclip use means severe intraprocedural bleeding.  Thus, it is appropriate to assess the degree
of bleeding during procedure.
Third, prolonged aPTT was important factor in this study. However, this is not cause of bleeding
tendency but reflect of bleeding tendency. Again, in my knowledge, prolonged aPTT itself is
not associated with bleeding tendency. Thus, this have to be elaborated.
assistant