Reviewer ’s report  
 
Title:  Severe colonic bleeding in ulcerative colitis is refractory to selective transcatheter arterial 
embolization  
 
Version: 0 Date: 29 Dec 2018 
 
Reviewer:  Wei-Chen  Lin 
 
Reviewer’s report:  
 
Miranda -Bautista et al. present three cases of massive haemorrhage in UC patients treated with 
transcatheter arterial embolization.  
 
Immediate technical success and rebleeding requiring subtotal colectomy occurred  after the 
procedure.  
 
Current guideline suggest surgical intervention should be done in UC patients without response 
to medical therapy.   
 
There are four comments to Author as below..  
 
 
1. Case report 2  
 
In this patient with steroid -dependent disease, did you do the sigmoidoscopy to take biopsy to 
exclude CMV infection possibility. I suggested you to mention it.  
 
 
2. Case report 3  
 
In this patient, could you provide the dose of oral mesalazine?  
 
Was the blee ding occurred suddenly and quickly in one day that you had no time to try the 
biologic agent?  
 
 
3. Discussion, paragraph 2  
 
You mentioned one report of an effective selective transcatheter embolization in a UC patient. If 
you saw the detail of this case, you  wound found bleeding might not relate to UC in this case.  
 
They mentioned "recent clinical, laboratory and endoscopic findings excluded a severe 
exacerbation of ulcerative colitis as the underlying cause of intractable bleeding." Endoscopy 
three weeks bef ore found no ulcer.  It may be related to other cause of bleeding, such as 
angiodyspalsia or diverticula bleeding.  
Therefore, bleeding could be control by selective transcatheter embolization  
 
In your cases, all patients were severe disease activity.  
 
I sug gested you to discuss more about the different situation between your cases and that 
successful case.  
 
 
4. Discussion,  paragraph 2  
 
I was interested about the decision of  transcatheter embolization(TAE).  
 
You mentioned a consensus decision between a " on c all" gastroenterologist, a colorectal 
surgeon, the radiologist and each patient.  
 
Did your medical team want to avoid urgent surgery and considered TAE as a bridge of 
temporary hemostasis.  
 
You wanted to postpone the surgery to regular work time?  
 
Or patien t hesitated about the surgery?  
 
I thought it might be another issue to re -consider the role of TAE in the UC patients with 
massive bleeding.   
 
In the real world practice, on call surgeon may not be skillful in such complicated procedure.  
 
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, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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 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:  
 
Acceptabl e 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following q uestions:  
 
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 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 the 
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 interests' 
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 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 includ ed 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:  Severe colonic bleeding in ulcerative colitis is refractory to selective transcatheter arterial 
embolization  
 
Version: 0 Date: 29 Dec 2018 
 
Reviewer:  Wei-Chen  Lin 
 
Reviewer’s report:  
 
Miranda -Bautista et al. present three cases of massive haemorrhage in UC patients treated with 
transcatheter arterial embolization.  
 
Immediate technical success and rebleeding requiring subtotal colectomy occurred  after the 
procedure.  
 
Current guideline suggest surgical intervention should be done in UC patients without response 
to medical therapy.   
 
There are four comments to Author as below..  
 
 
1. Case report 2  
 
In this patient with steroid -dependent disease, did you do the sigmoidoscopy to take biopsy to 
exclude CMV infection possibility. I suggested you to mention it.  
 
 
2. Case report 3  
 
In this patient, could you provide the dose of oral mesalazine?  
 
Was the blee ding occurred suddenly and quickly in one day that you had no time to try the 
biologic agent?  
 
 
3. Discussion, paragraph 2  
 
You mentioned one report of an effective selective transcatheter embolization in a UC patient. If 
you saw the detail of this case, you  wound found bleeding might not relate to UC in this case.  
 
They mentioned "recent clinical, laboratory and endoscopic findings excluded a severe 
exacerbation of ulcerative colitis as the underlying cause of intractable bleeding." Endoscopy 
three weeks bef ore found no ulcer.  It may be related to other cause of bleeding, such as 
angiodyspalsia or diverticula bleeding.  
Therefore, bleeding could be control by selective transcatheter embolization  
 
In your cases, all patients were severe disease activity.  
 
I sug gested you to discuss more about the different situation between your cases and that 
successful case.  
 
 
4. Discussion,  paragraph 2  
 
I was interested about the decision of  transcatheter embolization(TAE).  
 
You mentioned a consensus decision between a " on c all" gastroenterologist, a colorectal 
surgeon, the radiologist and each patient.  
 
Did your medical team want to avoid urgent surgery and considered TAE as a bridge of 
temporary hemostasis.  
 
You wanted to postpone the surgery to regular work time?  
 
Or patien t hesitated about the surgery?  
 
I thought it might be another issue to re -consider the role of TAE in the UC patients with 
massive bleeding.   
 
In the real world practice, on call surgeon may not be skillful in such complicated procedure.  
 
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, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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 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:  
 
Acceptabl e 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following q uestions:  
 
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 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 the 
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 interests' 
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 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 includ ed 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:  Severe colonic bleeding in ulcerative colitis is refractory to selective transcatheter arterial 
embolization  
 
Version: 0 Date: 29 Dec 2018 
 
Reviewer:  Wei-Chen  Lin 
 
Reviewer’s report:  
 
Miranda -Bautista et al. present three cases of massive haemorrhage in UC patients treated with 
transcatheter arterial embolization.  
 
Immediate technical success and rebleeding requiring subtotal colectomy occurred  after the 
procedure.  
 
Current guideline suggest surgical intervention should be done in UC patients without response 
to medical therapy.   
 
There are four comments to Author as below..  
 
 
1. Case report 2  
 
In this patient with steroid -dependent disease, did you do the sigmoidoscopy to take biopsy to 
exclude CMV infection possibility. I suggested you to mention it.  
 
 
2. Case report 3  
 
In this patient, could you provide the dose of oral mesalazine?  
 
Was the blee ding occurred suddenly and quickly in one day that you had no time to try the 
biologic agent?  
 
 
3. Discussion, paragraph 2  
 
You mentioned one report of an effective selective transcatheter embolization in a UC patient. If 
you saw the detail of this case, you  wound found bleeding might not relate to UC in this case.  
 
They mentioned "recent clinical, laboratory and endoscopic findings excluded a severe 
exacerbation of ulcerative colitis as the underlying cause of intractable bleeding." Endoscopy 
three weeks bef ore found no ulcer.  It may be related to other cause of bleeding, such as 
angiodyspalsia or diverticula bleeding.  
Therefore, bleeding could be control by selective transcatheter embolization  
 
In your cases, all patients were severe disease activity.  
 
I sug gested you to discuss more about the different situation between your cases and that 
successful case.  
 
 
4. Discussion,  paragraph 2  
 
I was interested about the decision of  transcatheter embolization(TAE).  
 
You mentioned a consensus decision between a " on c all" gastroenterologist, a colorectal 
surgeon, the radiologist and each patient.  
 
Did your medical team want to avoid urgent surgery and considered TAE as a bridge of 
temporary hemostasis.  
 
You wanted to postpone the surgery to regular work time?  
 
Or patien t hesitated about the surgery?  
 
I thought it might be another issue to re -consider the role of TAE in the UC patients with 
massive bleeding.   
 
In the real world practice, on call surgeon may not be skillful in such complicated procedure.  
 
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, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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 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:  
 
Acceptabl e 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following q uestions:  
 
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 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 the 
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 interests' 
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 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 includ ed 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