Reviewer ’s report  
 
Title: Novel modified endoscopic mucosal resection of la rge GI lesions (>20mm) using an 
external additional working channel (AWC) may improve R0 r esection rate: Initial clinical 
experience  
 
Version: 0 Date: 20 Feb 2020  
 
Reviewer: Hidekazu Takahashi  
 
Reviewer's report:  
 
This manuscript entitled "Nov el modified endoscopic mucosal resection of large GI lesions 
(&gt;20mm) using an external additional working channel (AWC) may improve R0 resection 
rate: Initial clinical experience" addresses a novel technology for convincing endoscopic 
resection of early  gastric and/or colorectal lesions. The concept presented by authors was 
potentially interesting and potentially effective for daily practice. As a pilot study, however, the 
study design should be on the feasibility of the authors' original technique (EMR+ ). I think this 
study is sufficient for publication in the BMC Gastroenterology.  
 
1. The critical point of this study was that the authors did not describe on the feasibility. It 
is necessary to examine the presence or absence of mucosal damage by endoscop y day after 
endoscopic treatment. Otherwise, the manuscript is only worth the experience of using new 
devise.  
 
2. Authors should show the micro -findings (histrological findings) of resected specimen. 
The rationale for R0 resection should be specified clea rly. 
 
3. Time required for complete the procedure should be specified at Table.  
 
Are the methods appropriate and well described?  
If no t, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by th e data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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 speci fy 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 : 
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, 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, eithe r 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 relatin g 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.  
 
none  
 
I agree to the open peer review policy of the journal. I understan d 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 alon g 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 included in my named report can be in cluded 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: Novel modified endoscopic mucosal resection of la rge GI lesions (>20mm) using an 
external additional working channel (AWC) may improve R0 r esection rate: Initial clinical 
experience  
 
Version: 0 Date: 20 Feb 2020  
 
Reviewer: Hidekazu Takahashi  
 
Reviewer's report:  
 
This manuscript entitled "Nov el modified endoscopic mucosal resection of large GI lesions 
(&gt;20mm) using an external additional working channel (AWC) may improve R0 resection 
rate: Initial clinical experience" addresses a novel technology for convincing endoscopic 
resection of early  gastric and/or colorectal lesions. The concept presented by authors was 
potentially interesting and potentially effective for daily practice. As a pilot study, however, the 
study design should be on the feasibility of the authors' original technique (EMR+ ). I think this 
study is sufficient for publication in the BMC Gastroenterology.  
 
1. The critical point of this study was that the authors did not describe on the feasibility. It 
is necessary to examine the presence or absence of mucosal damage by endoscop y day after 
endoscopic treatment. Otherwise, the manuscript is only worth the experience of using new 
devise.  
 
2. Authors should show the micro -findings (histrological findings) of resected specimen. 
The rationale for R0 resection should be specified clea rly. 
 
3. Time required for complete the procedure should be specified at Table.  
 
Are the methods appropriate and well described?  
If no t, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by th e data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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 speci fy 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 : 
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, 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, eithe r 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 relatin g 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.  
 
none  
 
I agree to the open peer review policy of the journal. I understan d 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 alon g 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 included in my named report can be in cluded 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: Novel modified endoscopic mucosal resection of la rge GI lesions (>20mm) using an 
external additional working channel (AWC) may improve R0 r esection rate: Initial clinical 
experience  
 
Version: 0 Date: 20 Feb 2020  
 
Reviewer: Hidekazu Takahashi  
 
Reviewer's report:  
 
This manuscript entitled "Nov el modified endoscopic mucosal resection of large GI lesions 
(&gt;20mm) using an external additional working channel (AWC) may improve R0 resection 
rate: Initial clinical experience" addresses a novel technology for convincing endoscopic 
resection of early  gastric and/or colorectal lesions. The concept presented by authors was 
potentially interesting and potentially effective for daily practice. As a pilot study, however, the 
study design should be on the feasibility of the authors' original technique (EMR+ ). I think this 
study is sufficient for publication in the BMC Gastroenterology.  
 
1. The critical point of this study was that the authors did not describe on the feasibility. It 
is necessary to examine the presence or absence of mucosal damage by endoscop y day after 
endoscopic treatment. Otherwise, the manuscript is only worth the experience of using new 
devise.  
 
2. Authors should show the micro -findings (histrological findings) of resected specimen. 
The rationale for R0 resection should be specified clea rly. 
 
3. Time required for complete the procedure should be specified at Table.  
 
Are the methods appropriate and well described?  
If no t, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by th e data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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 speci fy 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 : 
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, 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, eithe r 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 relatin g 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.  
 
none  
 
I agree to the open peer review policy of the journal. I understan d 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 alon g 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 included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant