Reviewer ’s report  
 
Title: Treatment of long -segment Barrett's adenocarcinoma by complete circular endoscopic 
submucosal dissection: a case report  
 
Version: 1 Date: 29 Nov 2017  
 
Reviewer: Michael Sey  
 
Reviewer's report:  
 
This is a very interesting case report of a circumferential ESD of a LSBE with superficial EAC.  
 
My comments are as follows:  
Line 81 -I found the EUS images somewhat blurry to be able to accept that there was no SM 
invasion.  What frequency was the EUS performed at?  Also, please label the layers on the EUS 
image fo r readers who may not perform EUS.   Also, I would suggest using the name of the 
layers seen on EUS rather than the first, second, third layers...etc (ie. call third layer the 
submucosa instead).  
Line 91 -I would like to have read more details about how th e ESD was done.  This will be very 
technical although given this is a case report of an advanced technique, I think there's room here 
to expand.  
Line 105: How was the 40 point injection spread out (ie. 4 quadrants every 0.5 mm)?  
Line 110: What proteinase  inhibitor was used?  What prokinetic agent was used?  What dose?  
Please use generic names.  
Line  114: What is the definition of "severe dysphagia"?  Did he have any dysphagia?   
Line 115: What is the definition of "severe esophageal stricture"?  Was there any stricture?  
Figure 2: This is the best part of the paper!!  Please include more images of each step in 
achieving this massive ESD.  
Figure 3: Please label the histology image s (ie. where the submucosa begins)  
Other points to consider.  How long did the case take?  How long was the patient hospitalized 
for?  Any issues with pneumomediastinum, mediastinitis, or bleeding?  
 
 
 
Are the methods appropriate 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 drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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 specify 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 langu age in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimburs ements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 a ll of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests' below  
 
I agree to the open peer review policy of the journal. I understand tha t 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 included 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: Treatment of long -segment Barrett's adenocarcinoma by complete circular endoscopic 
submucosal dissection: a case report  
 
Version: 1 Date: 29 Nov 2017  
 
Reviewer: Michael Sey  
 
Reviewer's report:  
 
This is a very interesting case report of a circumferential ESD of a LSBE with superficial EAC.  
 
My comments are as follows:  
Line 81 -I found the EUS images somewhat blurry to be able to accept that there was no SM 
invasion.  What frequency was the EUS performed at?  Also, please label the layers on the EUS 
image fo r readers who may not perform EUS.   Also, I would suggest using the name of the 
layers seen on EUS rather than the first, second, third layers...etc (ie. call third layer the 
submucosa instead).  
Line 91 -I would like to have read more details about how th e ESD was done.  This will be very 
technical although given this is a case report of an advanced technique, I think there's room here 
to expand.  
Line 105: How was the 40 point injection spread out (ie. 4 quadrants every 0.5 mm)?  
Line 110: What proteinase  inhibitor was used?  What prokinetic agent was used?  What dose?  
Please use generic names.  
Line  114: What is the definition of "severe dysphagia"?  Did he have any dysphagia?   
Line 115: What is the definition of "severe esophageal stricture"?  Was there any stricture?  
Figure 2: This is the best part of the paper!!  Please include more images of each step in 
achieving this massive ESD.  
Figure 3: Please label the histology image s (ie. where the submucosa begins)  
Other points to consider.  How long did the case take?  How long was the patient hospitalized 
for?  Any issues with pneumomediastinum, mediastinitis, or bleeding?  
 
 
 
Are the methods appropriate 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 drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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 specify 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 langu age in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimburs ements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 a ll of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests' below  
 
I agree to the open peer review policy of the journal. I understand tha t 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 included 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: Treatment of long -segment Barrett's adenocarcinoma by complete circular endoscopic 
submucosal dissection: a case report  
 
Version: 1 Date: 29 Nov 2017  
 
Reviewer: Michael Sey  
 
Reviewer's report:  
 
This is a very interesting case report of a circumferential ESD of a LSBE with superficial EAC.  
 
My comments are as follows:  
Line 81 -I found the EUS images somewhat blurry to be able to accept that there was no SM 
invasion.  What frequency was the EUS performed at?  Also, please label the layers on the EUS 
image fo r readers who may not perform EUS.   Also, I would suggest using the name of the 
layers seen on EUS rather than the first, second, third layers...etc (ie. call third layer the 
submucosa instead).  
Line 91 -I would like to have read more details about how th e ESD was done.  This will be very 
technical although given this is a case report of an advanced technique, I think there's room here 
to expand.  
Line 105: How was the 40 point injection spread out (ie. 4 quadrants every 0.5 mm)?  
Line 110: What proteinase  inhibitor was used?  What prokinetic agent was used?  What dose?  
Please use generic names.  
Line  114: What is the definition of "severe dysphagia"?  Did he have any dysphagia?   
Line 115: What is the definition of "severe esophageal stricture"?  Was there any stricture?  
Figure 2: This is the best part of the paper!!  Please include more images of each step in 
achieving this massive ESD.  
Figure 3: Please label the histology image s (ie. where the submucosa begins)  
Other points to consider.  How long did the case take?  How long was the patient hospitalized 
for?  Any issues with pneumomediastinum, mediastinitis, or bleeding?  
 
 
 
Are the methods appropriate 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 drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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 specify 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 langu age in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimburs ements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 a ll of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests' below  
 
I agree to the open peer review policy of the journal. I understand tha t 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 included as confidential comments  
to the editors, which  will not be published.  
 
I agree to the open peer review policy of the journal  
assistant