Reviewer's report
Title:Closure of iatrogenic large mucosal and full-thickness defects of the
stomach with endoscopic interrupted sutures in in vivo porcine models: Are they
durable enough?
Version:3Date:14 November 2014
Reviewer: Hideki Kobara
Reviewer's report:
Reviewer's report
Title: Closure of iatrogenic large mucosal and full-thickness defects of the
stomach with endoscopic interrupted sutures in in vivo porcine models: Are they
durable enough?
Version: 1 Date: 14 November 2014
Reviewer: Hideki Kobara
Reviewer's report:
There are few reports regarding endoluminal complete closure of full-thickness
gastric wall defects with use of an innovative endoscopic suturing device,
Overstitch. By using Overstitch, authors describe an amazing experience and
show outstanding knowledge of gastric endoscopic full-thickness resection
(EFTR), compared to stitching closure of large mucosal defects created by
endoscopic submucosal dissection (ESD) in the animal models. The result of this
study is excellent and suitable for multidisciplinary approaches, and leads to
further advances of minimally invasive endoscopic surgery.
Additionally, the strength of the present study can be evaluated for readers as
follows;
1. The design of EFTR procedure is very unique and interesting.
T-tag tissue apposition system creates a precise operation field, which prevents
the stomach from collapsing. It makes full-thickness suturing possible.
2. “Secondary closure success rate” of this one-week survival study is quite
interesting.
Although benefits of prophylactic closure for mucosal defects after colorectal
EMR are well-established, this result suggests that superficial gastric mucosal
stitching involves some limitations, which prevent delayed adverse events. The
reason is well-stated in the discussion section.
3. Histological examination of autopsy nicely reveals that serosal stitching is
durable and appropriate for EFTR. The reason is mentioned clearly and
reasonably in the discussion section “reduced by disrupting the muscular fibers
with EFTR, having a similar theory to Heller’s myotomy.”
However, I have several comments and criticisms as following.
Major
1) The reason of significant differences of median procedure time between ESD
and EFTR groups should be explained.
If some factors (the difficulty of maneuvering devices or technique, the number of
stitches, the degree of wall thickness, etc.) influence them, please mention it in
the discussion section.
2) Please describe about limitations or tasks for the achievement of EFTR by the
present methodology.
For example, add some information like this; “At present, EFTR with T-bar
anchors has a limited function regarding the location of stomach. This fact
indicates necessity of further developments to establish EFTR.”
Minor
1) Please correct careless mistakes.
The P-values of the mean maximum diameter in the Results section (p = 0.002),
and Table1 (p = 0.015) are different.
Level of interest: An exceptional article
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
None
Reviewer's report
Title:Closure of iatrogenic large mucosal and full-thickness defects of the
stomach with endoscopic interrupted sutures in in vivo porcine models: Are they
durable enough?
Version:3Date:14 November 2014
Reviewer: Hideki Kobara
Reviewer's report:
Reviewer's report
Title: Closure of iatrogenic large mucosal and full-thickness defects of the
stomach with endoscopic interrupted sutures in in vivo porcine models: Are they
durable enough?
Version: 1 Date: 14 November 2014
Reviewer: Hideki Kobara
Reviewer's report:
There are few reports regarding endoluminal complete closure of full-thickness
gastric wall defects with use of an innovative endoscopic suturing device,
Overstitch. By using Overstitch, authors describe an amazing experience and
show outstanding knowledge of gastric endoscopic full-thickness resection
(EFTR), compared to stitching closure of large mucosal defects created by
endoscopic submucosal dissection (ESD) in the animal models. The result of this
study is excellent and suitable for multidisciplinary approaches, and leads to
further advances of minimally invasive endoscopic surgery.
Additionally, the strength of the present study can be evaluated for readers as
follows;
1. The design of EFTR procedure is very unique and interesting.
T-tag tissue apposition system creates a precise operation field, which prevents
the stomach from collapsing. It makes full-thickness suturing possible.
2. “Secondary closure success rate” of this one-week survival study is quite
interesting.
Although benefits of prophylactic closure for mucosal defects after colorectal
EMR are well-established, this result suggests that superficial gastric mucosal
stitching involves some limitations, which prevent delayed adverse events. The
reason is well-stated in the discussion section.
3. Histological examination of autopsy nicely reveals that serosal stitching is
durable and appropriate for EFTR. The reason is mentioned clearly and
reasonably in the discussion section “reduced by disrupting the muscular fibers
with EFTR, having a similar theory to Heller’s myotomy.”
However, I have several comments and criticisms as following.
Major
1) The reason of significant differences of median procedure time between ESD
and EFTR groups should be explained.
If some factors (the difficulty of maneuvering devices or technique, the number of
stitches, the degree of wall thickness, etc.) influence them, please mention it in
the discussion section.
2) Please describe about limitations or tasks for the achievement of EFTR by the
present methodology.
For example, add some information like this; “At present, EFTR with T-bar
anchors has a limited function regarding the location of stomach. This fact
indicates necessity of further developments to establish EFTR.”
Minor
1) Please correct careless mistakes.
The P-values of the mean maximum diameter in the Results section (p = 0.002),
and Table1 (p = 0.015) are different.
Level of interest: An exceptional article
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
None
Please review this paper.
user
Reviewer's report
Title:Closure of iatrogenic large mucosal and full-thickness defects of the
stomach with endoscopic interrupted sutures in in vivo porcine models: Are they
durable enough?
Version:3Date:14 November 2014
Reviewer: Hideki Kobara
Reviewer's report:
Reviewer's report
Title: Closure of iatrogenic large mucosal and full-thickness defects of the
stomach with endoscopic interrupted sutures in in vivo porcine models: Are they
durable enough?
Version: 1 Date: 14 November 2014
Reviewer: Hideki Kobara
Reviewer's report:
There are few reports regarding endoluminal complete closure of full-thickness
gastric wall defects with use of an innovative endoscopic suturing device,
Overstitch. By using Overstitch, authors describe an amazing experience and
show outstanding knowledge of gastric endoscopic full-thickness resection
(EFTR), compared to stitching closure of large mucosal defects created by
endoscopic submucosal dissection (ESD) in the animal models. The result of this
study is excellent and suitable for multidisciplinary approaches, and leads to
further advances of minimally invasive endoscopic surgery.
Additionally, the strength of the present study can be evaluated for readers as
follows;
1. The design of EFTR procedure is very unique and interesting.
T-tag tissue apposition system creates a precise operation field, which prevents
the stomach from collapsing. It makes full-thickness suturing possible.
2. “Secondary closure success rate” of this one-week survival study is quite
interesting.
Although benefits of prophylactic closure for mucosal defects after colorectal
EMR are well-established, this result suggests that superficial gastric mucosal
stitching involves some limitations, which prevent delayed adverse events. The
reason is well-stated in the discussion section.
3. Histological examination of autopsy nicely reveals that serosal stitching is
durable and appropriate for EFTR. The reason is mentioned clearly and
reasonably in the discussion section “reduced by disrupting the muscular fibers
with EFTR, having a similar theory to Heller’s myotomy.”
However, I have several comments and criticisms as following.
Major
1) The reason of significant differences of median procedure time between ESD
and EFTR groups should be explained.
If some factors (the difficulty of maneuvering devices or technique, the number of
stitches, the degree of wall thickness, etc.) influence them, please mention it in
the discussion section.
2) Please describe about limitations or tasks for the achievement of EFTR by the
present methodology.
For example, add some information like this; “At present, EFTR with T-bar
anchors has a limited function regarding the location of stomach. This fact
indicates necessity of further developments to establish EFTR.”
Minor
1) Please correct careless mistakes.
The P-values of the mean maximum diameter in the Results section (p = 0.002),
and Table1 (p = 0.015) are different.
Level of interest: An exceptional article
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
None
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