Reviewer’s report  
 
Title: Clinical impact of the perioperative management of oral a nticoagulants in bleeding after 
colonic endoscopic mucosal resection  
 
Version: 0 Date: 03 Aug 2019  
 
Reviewer: Yosuke Tsuji  
 
Reviewer's report:  
 
In the present study, authors investigated the post -EMR bleeding rate, especially focusing on the 
patients taking antithrombotic agents. Heparin bridge therapy (HBT) has recently reported to be 
a high risk for post -EMR bleeding, and so the perioperative ma nagement of antithrombotic 
agents without HBT has been considered to be better. In this study, cases with continuous use of 
warfarin or one -day skip of DOACs are included, so in this regard this study is quite informative.  
 
 
Major comments:  
 
1. The aim of thi s study might be elucidating the perioperative management of 
anticoagulants without HBT. Then, in order to investigate it, it is more appropriate to 
compare anticoagulants takers with HBT and those without HBT (continuous warfarin or 
one-day skip of DOACs) . However, because of a small sample size, authors could not 
demonstrate a significant difference in post -EMR bleeding rate between those two groups 
and they compared a control group not taking antithrombotic agents with the other 
groups. This is an unigno rable limitation.  
 
2. In Tables 3 and 4, it is difficult to know whether risk -per-polyp or risk -per-patient is 
treated. For example, Table 3 shows the number of HBT group is 31, but Table 4 showed 
32. Please add an explanation.  
 
Are the methods appropria te 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.  
 
Yes 
 
Are the conclusions dr awn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is r ecommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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 financially fro m 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, 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 int erests' 
below. If you r 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 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 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 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: Clinical impact of the perioperative management of oral a nticoagulants in bleeding after 
colonic endoscopic mucosal resection  
 
Version: 0 Date: 03 Aug 2019  
 
Reviewer: Yosuke Tsuji  
 
Reviewer's report:  
 
In the present study, authors investigated the post -EMR bleeding rate, especially focusing on the 
patients taking antithrombotic agents. Heparin bridge therapy (HBT) has recently reported to be 
a high risk for post -EMR bleeding, and so the perioperative ma nagement of antithrombotic 
agents without HBT has been considered to be better. In this study, cases with continuous use of 
warfarin or one -day skip of DOACs are included, so in this regard this study is quite informative.  
 
 
Major comments:  
 
1. The aim of thi s study might be elucidating the perioperative management of 
anticoagulants without HBT. Then, in order to investigate it, it is more appropriate to 
compare anticoagulants takers with HBT and those without HBT (continuous warfarin or 
one-day skip of DOACs) . However, because of a small sample size, authors could not 
demonstrate a significant difference in post -EMR bleeding rate between those two groups 
and they compared a control group not taking antithrombotic agents with the other 
groups. This is an unigno rable limitation.  
 
2. In Tables 3 and 4, it is difficult to know whether risk -per-polyp or risk -per-patient is 
treated. For example, Table 3 shows the number of HBT group is 31, but Table 4 showed 
32. Please add an explanation.  
 
Are the methods appropria te 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.  
 
Yes 
 
Are the conclusions dr awn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is r ecommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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 financially fro m 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, 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 int erests' 
below. If you r 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 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 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 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: Clinical impact of the perioperative management of oral a nticoagulants in bleeding after 
colonic endoscopic mucosal resection  
 
Version: 0 Date: 03 Aug 2019  
 
Reviewer: Yosuke Tsuji  
 
Reviewer's report:  
 
In the present study, authors investigated the post -EMR bleeding rate, especially focusing on the 
patients taking antithrombotic agents. Heparin bridge therapy (HBT) has recently reported to be 
a high risk for post -EMR bleeding, and so the perioperative ma nagement of antithrombotic 
agents without HBT has been considered to be better. In this study, cases with continuous use of 
warfarin or one -day skip of DOACs are included, so in this regard this study is quite informative.  
 
 
Major comments:  
 
1. The aim of thi s study might be elucidating the perioperative management of 
anticoagulants without HBT. Then, in order to investigate it, it is more appropriate to 
compare anticoagulants takers with HBT and those without HBT (continuous warfarin or 
one-day skip of DOACs) . However, because of a small sample size, authors could not 
demonstrate a significant difference in post -EMR bleeding rate between those two groups 
and they compared a control group not taking antithrombotic agents with the other 
groups. This is an unigno rable limitation.  
 
2. In Tables 3 and 4, it is difficult to know whether risk -per-polyp or risk -per-patient is 
treated. For example, Table 3 shows the number of HBT group is 31, but Table 4 showed 
32. Please add an explanation.  
 
Are the methods appropria te 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.  
 
Yes 
 
Are the conclusions dr awn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is r ecommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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 financially fro m 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, 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 int erests' 
below. If you r 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 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 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 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