Title: Optimal Endoscopy Timing in Elderly Patients Presenting with Acute Non-Variceal
Upper Gastrointestinal Bleeding.
Version: 4 Date: 03 Aug 2024
Reviewer:  Riccardo Marmo
Reviewer's report:
The authors stated that the sample size was determined as 159 patients by taking the effect size
as 0.25, #=0.05, and power (1-#) =0.80 at a 95% confidence level; please report the reference.
The dimension  of the effect seems very high, the overall mortality observed  was 10.7%. Do
the  authors refer  to 25% of  relative risk reduction? If so, the sample size must be re-evaluated.
In the table 4 the authors splitted the sample size in three subgroups and than in two arms;  each
arm  includes  < 159 patients.
The authors stated “Patients presenting with severe bleeding,   had endoscopies within the
first 12 hours. Endoscopy was scheduled as soon as possible after 12 hours for patients whose
hemodynamically were stable. As a result, there could be discrepancies in the results if the
group that had an endoscopy within the first 12 hours had worse outcomes.” This point is very
important so that the timing to endoscopy must be included as covariate in a multiple logistic
regression.
In table 4 was clearly documented that the mortality varies by  timing to endoscopy according to
the two age groups. The clinical picture of the two groups are statistically different as reported
in table 1.
The authors try to document that age > 65 years is an independent  risk factor for the primary
outcome regardless of the timing to endoscopy and other factors (e.g. comorbidities) that can
influence the outcome investigated.
Title: Optimal Endoscopy Timing in Elderly Patients Presenting with Acute Non-Variceal
Upper Gastrointestinal Bleeding.
Version: 4 Date: 03 Aug 2024
Reviewer:  Riccardo Marmo
Reviewer's report:
The authors stated that the sample size was determined as 159 patients by taking the effect size
as 0.25, #=0.05, and power (1-#) =0.80 at a 95% confidence level; please report the reference.
The dimension  of the effect seems very high, the overall mortality observed  was 10.7%. Do
the  authors refer  to 25% of  relative risk reduction? If so, the sample size must be re-evaluated.
In the table 4 the authors splitted the sample size in three subgroups and than in two arms;  each
arm  includes  < 159 patients.
The authors stated “Patients presenting with severe bleeding,   had endoscopies within the
first 12 hours. Endoscopy was scheduled as soon as possible after 12 hours for patients whose
hemodynamically were stable. As a result, there could be discrepancies in the results if the
group that had an endoscopy within the first 12 hours had worse outcomes.” This point is very
important so that the timing to endoscopy must be included as covariate in a multiple logistic
regression.
In table 4 was clearly documented that the mortality varies by  timing to endoscopy according to
the two age groups. The clinical picture of the two groups are statistically different as reported
in table 1.
The authors try to document that age > 65 years is an independent  risk factor for the primary
outcome regardless of the timing to endoscopy and other factors (e.g. comorbidities) that can
influence the outcome investigated.
Please review this paper.
user
Title: Optimal Endoscopy Timing in Elderly Patients Presenting with Acute Non-Variceal
Upper Gastrointestinal Bleeding.
Version: 4 Date: 03 Aug 2024
Reviewer:  Riccardo Marmo
Reviewer's report:
The authors stated that the sample size was determined as 159 patients by taking the effect size
as 0.25, #=0.05, and power (1-#) =0.80 at a 95% confidence level; please report the reference.
The dimension  of the effect seems very high, the overall mortality observed  was 10.7%. Do
the  authors refer  to 25% of  relative risk reduction? If so, the sample size must be re-evaluated.
In the table 4 the authors splitted the sample size in three subgroups and than in two arms;  each
arm  includes  < 159 patients.
The authors stated “Patients presenting with severe bleeding,   had endoscopies within the
first 12 hours. Endoscopy was scheduled as soon as possible after 12 hours for patients whose
hemodynamically were stable. As a result, there could be discrepancies in the results if the
group that had an endoscopy within the first 12 hours had worse outcomes.” This point is very
important so that the timing to endoscopy must be included as covariate in a multiple logistic
regression.
In table 4 was clearly documented that the mortality varies by  timing to endoscopy according to
the two age groups. The clinical picture of the two groups are statistically different as reported
in table 1.
The authors try to document that age > 65 years is an independent  risk factor for the primary
outcome regardless of the timing to endoscopy and other factors (e.g. comorbidities) that can
influence the outcome investigated.
assistant