Title: Triage policy to postpone endoscopy for patients with low-risk varices is safe during the
lockdown period of COVID-19 pandemic
Version: 2 Date: 23 May 2023
Reviewer's report:
Chen YJ and colleagues performed a retrospective study aimed to assess the safety of a triage
policy in patients receiving esophageal variceal ligation during the COVID-19 pandemic. The
manuscript is attractive and well written. Nevertheless, it presents some minor points that need
to be addressed, as follows:
Minor issues
1) In the introduction it would be useful to add some additional data on the current management
of oesophageal varices according last updated guidelines. Consider including some information
and citing this paper:
-Diagnosis and Management of Esophagogastric Varices. Diagnostics (Basel). 2023 Mar
8;13(6):1031 . doi:10.3390/diagnostics13061031. PMID: 36980343; PMC ID: PMC10047815.
2)Concerning the impact of Covid pandemic on GI activities and GI training (that is also
indirectly involved in EVL), the authors should consider citing these papers that provide relevant
data on the topic.
-Impact of the COVID-19 pandemic on Gastroenterology Divisions in Italy: a national survey.
Dig Liver Dis . 2020 May 16.  doi: 10.1016/j.dld.2020.05.017.  Online ahead of print.
-Impact of COVID-19 outbreak on clinical practice and training of young gastroenterologists:
A European survey. Dig Liver Dis. 2020 May 23:S1590-8658(20)30233-4. doi: 10.1016/
j.dld.2020.05.023. Epub ahead of print. PMID: 32507619
3) Please cite the consensus of Baveno VII, not Baevno VI since it has been updated.
- de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII
- Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-974. doi: 10.1016/
j.jhep.2021.12.022. Epub 2021 Dec 30. Erratum in: J Hepatol. 2022 Apr 14;: PMID: 35120736.
4) The authors correctly stated that according to Baveno consensus either NSBBs or endoscopic
band ligation is recommended for the prevention of the first variceal bleeding of medium or
large varices.
Nevertheless, according the new statement of Baveno VII, in patients with high-risk varices
(large varices, or red spot signs, or Child-Pugh C), prevention of first variceal hemorrhage is
indicated, with traditional NSBBs or carvedilol being preferred over EVL.
In contrast, the study protocol assigned EVL as the sole method of primary prophylaxis. This
attitude, now obsolete, which goes against the current guidelines, should be clarified, explaining
that there were different recommendations during the period of the study.
5)The results refer to a strategy adopted during the lockdown. However, the authors need to
explain what impact this finding may have on clinical practice outside the pandemic, especially
whether the data may be sufficient to support mitigated surveillance or not.
6)The manuscript has numerous typos (eg “Childs Pugh”, “developping”) and needs
proofreading by a native speaker.
Title: Triage policy to postpone endoscopy for patients with low-risk varices is safe during the
lockdown period of COVID-19 pandemic
Version: 2 Date: 23 May 2023
Reviewer's report:
Chen YJ and colleagues performed a retrospective study aimed to assess the safety of a triage
policy in patients receiving esophageal variceal ligation during the COVID-19 pandemic. The
manuscript is attractive and well written. Nevertheless, it presents some minor points that need
to be addressed, as follows:
Minor issues
1) In the introduction it would be useful to add some additional data on the current management
of oesophageal varices according last updated guidelines. Consider including some information
and citing this paper:
-Diagnosis and Management of Esophagogastric Varices. Diagnostics (Basel). 2023 Mar
8;13(6):1031 . doi:10.3390/diagnostics13061031. PMID: 36980343; PMC ID: PMC10047815.
2)Concerning the impact of Covid pandemic on GI activities and GI training (that is also
indirectly involved in EVL), the authors should consider citing these papers that provide relevant
data on the topic.
-Impact of the COVID-19 pandemic on Gastroenterology Divisions in Italy: a national survey.
Dig Liver Dis . 2020 May 16.  doi: 10.1016/j.dld.2020.05.017.  Online ahead of print.
-Impact of COVID-19 outbreak on clinical practice and training of young gastroenterologists:
A European survey. Dig Liver Dis. 2020 May 23:S1590-8658(20)30233-4. doi: 10.1016/
j.dld.2020.05.023. Epub ahead of print. PMID: 32507619
3) Please cite the consensus of Baveno VII, not Baevno VI since it has been updated.
- de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII
- Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-974. doi: 10.1016/
j.jhep.2021.12.022. Epub 2021 Dec 30. Erratum in: J Hepatol. 2022 Apr 14;: PMID: 35120736.
4) The authors correctly stated that according to Baveno consensus either NSBBs or endoscopic
band ligation is recommended for the prevention of the first variceal bleeding of medium or
large varices.
Nevertheless, according the new statement of Baveno VII, in patients with high-risk varices
(large varices, or red spot signs, or Child-Pugh C), prevention of first variceal hemorrhage is
indicated, with traditional NSBBs or carvedilol being preferred over EVL.
In contrast, the study protocol assigned EVL as the sole method of primary prophylaxis. This
attitude, now obsolete, which goes against the current guidelines, should be clarified, explaining
that there were different recommendations during the period of the study.
5)The results refer to a strategy adopted during the lockdown. However, the authors need to
explain what impact this finding may have on clinical practice outside the pandemic, especially
whether the data may be sufficient to support mitigated surveillance or not.
6)The manuscript has numerous typos (eg “Childs Pugh”, “developping”) and needs
proofreading by a native speaker.
Please review this paper.
user
Title: Triage policy to postpone endoscopy for patients with low-risk varices is safe during the
lockdown period of COVID-19 pandemic
Version: 2 Date: 23 May 2023
Reviewer's report:
Chen YJ and colleagues performed a retrospective study aimed to assess the safety of a triage
policy in patients receiving esophageal variceal ligation during the COVID-19 pandemic. The
manuscript is attractive and well written. Nevertheless, it presents some minor points that need
to be addressed, as follows:
Minor issues
1) In the introduction it would be useful to add some additional data on the current management
of oesophageal varices according last updated guidelines. Consider including some information
and citing this paper:
-Diagnosis and Management of Esophagogastric Varices. Diagnostics (Basel). 2023 Mar
8;13(6):1031 . doi:10.3390/diagnostics13061031. PMID: 36980343; PMC ID: PMC10047815.
2)Concerning the impact of Covid pandemic on GI activities and GI training (that is also
indirectly involved in EVL), the authors should consider citing these papers that provide relevant
data on the topic.
-Impact of the COVID-19 pandemic on Gastroenterology Divisions in Italy: a national survey.
Dig Liver Dis . 2020 May 16.  doi: 10.1016/j.dld.2020.05.017.  Online ahead of print.
-Impact of COVID-19 outbreak on clinical practice and training of young gastroenterologists:
A European survey. Dig Liver Dis. 2020 May 23:S1590-8658(20)30233-4. doi: 10.1016/
j.dld.2020.05.023. Epub ahead of print. PMID: 32507619
3) Please cite the consensus of Baveno VII, not Baevno VI since it has been updated.
- de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII
- Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-974. doi: 10.1016/
j.jhep.2021.12.022. Epub 2021 Dec 30. Erratum in: J Hepatol. 2022 Apr 14;: PMID: 35120736.
4) The authors correctly stated that according to Baveno consensus either NSBBs or endoscopic
band ligation is recommended for the prevention of the first variceal bleeding of medium or
large varices.
Nevertheless, according the new statement of Baveno VII, in patients with high-risk varices
(large varices, or red spot signs, or Child-Pugh C), prevention of first variceal hemorrhage is
indicated, with traditional NSBBs or carvedilol being preferred over EVL.
In contrast, the study protocol assigned EVL as the sole method of primary prophylaxis. This
attitude, now obsolete, which goes against the current guidelines, should be clarified, explaining
that there were different recommendations during the period of the study.
5)The results refer to a strategy adopted during the lockdown. However, the authors need to
explain what impact this finding may have on clinical practice outside the pandemic, especially
whether the data may be sufficient to support mitigated surveillance or not.
6)The manuscript has numerous typos (eg “Childs Pugh”, “developping”) and needs
proofreading by a native speaker.
assistant