Reviewer's report
Title:Giant flat adenomas of rectum successfully treated in two steps by
endoscopic submucosal dissection and endoscopic mucosal resection.
Version: 1Date:6 March 2010
Reviewer: Hiroyuki Imaeda
Reviewer's report:
The major revisions
1. Authors need to mention the endoscopic procedure time of each case.
2. Authors performed combined ESD/EMR. Wasn’t it difficult to examine
histopathologic assessment of the resected specimens because of piecemeal
resection?
3. Authors mentioned the difficulty in assessing the correct deeper submucosal
tissue plane in the center of the tumors. Was the cause the submucosal fibrosis
or bleeding?
4. Accurate histopathologic assessment of the resected specimens is essential
because the depth of the invasion and lymphovascular infiltration of the tumor is
associated with considerable risk for lymph node metastasis. However, large,
flat-elevated colorectal tumors tend to have a relatively benign course, and,
hence, endoscopic removal by using piecemeal EMR techniques has become
accepted. Authors should discuss this in Discussion.
5. Figure 1: Authors showed the figure of the resected site in D, but some part of
the lesion seemed to remain in the oral side. Authors need to show the figure of
the clearer resected site. Moreover, authors showed the figure of the scar after 3
months, but the ordinary scar after EMR/ESD looks as Figure 2e and Figure 3f.
Why was the scar reddish and granular?
The minor revisions
1. p2, line 18: Authors should change ‘‘gastrointestinal’’ to ‘‘rectal’’.
2. p5, line 7: Authors mentioned ‘‘hood knife’’. Was it hook knife?
3. p6, line 19: Authors mentioned other systems in Discussion, but authors
should mention it in Case reports.
4. p6, line 20: Authors should refer the manuscript of ESD methods using a thin
gastroscope reported by Uraoka et al (Gastrointest Endosc 2007;66:836).
5. p10, Figure 2 and 3: Authors mentioned ‘‘anterior’’. Was it anal side?
6. p7, line 18: Authors should omit ‘‘(Hooke-EMR)’’.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Giant flat adenomas of rectum successfully treated in two steps by
endoscopic submucosal dissection and endoscopic mucosal resection.
Version: 1Date:6 March 2010
Reviewer: Hiroyuki Imaeda
Reviewer's report:
The major revisions
1. Authors need to mention the endoscopic procedure time of each case.
2. Authors performed combined ESD/EMR. Wasn’t it difficult to examine
histopathologic assessment of the resected specimens because of piecemeal
resection?
3. Authors mentioned the difficulty in assessing the correct deeper submucosal
tissue plane in the center of the tumors. Was the cause the submucosal fibrosis
or bleeding?
4. Accurate histopathologic assessment of the resected specimens is essential
because the depth of the invasion and lymphovascular infiltration of the tumor is
associated with considerable risk for lymph node metastasis. However, large,
flat-elevated colorectal tumors tend to have a relatively benign course, and,
hence, endoscopic removal by using piecemeal EMR techniques has become
accepted. Authors should discuss this in Discussion.
5. Figure 1: Authors showed the figure of the resected site in D, but some part of
the lesion seemed to remain in the oral side. Authors need to show the figure of
the clearer resected site. Moreover, authors showed the figure of the scar after 3
months, but the ordinary scar after EMR/ESD looks as Figure 2e and Figure 3f.
Why was the scar reddish and granular?
The minor revisions
1. p2, line 18: Authors should change ‘‘gastrointestinal’’ to ‘‘rectal’’.
2. p5, line 7: Authors mentioned ‘‘hood knife’’. Was it hook knife?
3. p6, line 19: Authors mentioned other systems in Discussion, but authors
should mention it in Case reports.
4. p6, line 20: Authors should refer the manuscript of ESD methods using a thin
gastroscope reported by Uraoka et al (Gastrointest Endosc 2007;66:836).
5. p10, Figure 2 and 3: Authors mentioned ‘‘anterior’’. Was it anal side?
6. p7, line 18: Authors should omit ‘‘(Hooke-EMR)’’.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Giant flat adenomas of rectum successfully treated in two steps by
endoscopic submucosal dissection and endoscopic mucosal resection.
Version: 1Date:6 March 2010
Reviewer: Hiroyuki Imaeda
Reviewer's report:
The major revisions
1. Authors need to mention the endoscopic procedure time of each case.
2. Authors performed combined ESD/EMR. Wasn’t it difficult to examine
histopathologic assessment of the resected specimens because of piecemeal
resection?
3. Authors mentioned the difficulty in assessing the correct deeper submucosal
tissue plane in the center of the tumors. Was the cause the submucosal fibrosis
or bleeding?
4. Accurate histopathologic assessment of the resected specimens is essential
because the depth of the invasion and lymphovascular infiltration of the tumor is
associated with considerable risk for lymph node metastasis. However, large,
flat-elevated colorectal tumors tend to have a relatively benign course, and,
hence, endoscopic removal by using piecemeal EMR techniques has become
accepted. Authors should discuss this in Discussion.
5. Figure 1: Authors showed the figure of the resected site in D, but some part of
the lesion seemed to remain in the oral side. Authors need to show the figure of
the clearer resected site. Moreover, authors showed the figure of the scar after 3
months, but the ordinary scar after EMR/ESD looks as Figure 2e and Figure 3f.
Why was the scar reddish and granular?
The minor revisions
1. p2, line 18: Authors should change ‘‘gastrointestinal’’ to ‘‘rectal’’.
2. p5, line 7: Authors mentioned ‘‘hood knife’’. Was it hook knife?
3. p6, line 19: Authors mentioned other systems in Discussion, but authors
should mention it in Case reports.
4. p6, line 20: Authors should refer the manuscript of ESD methods using a thin
gastroscope reported by Uraoka et al (Gastrointest Endosc 2007;66:836).
5. p10, Figure 2 and 3: Authors mentioned ‘‘anterior’’. Was it anal side?
6. p7, line 18: Authors should omit ‘‘(Hooke-EMR)’’.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
assistant