Reviewer ’s report  
 
Title: Re-bleeding and its predictors after capsule end oscopy in patients with obscure 
gastrointestinal bleeding in long -term follow -up 
 
Version: 0 Date: 10 Jul 2019  
 
Reviewer: Cristiano Spada  
 
Reviewer's report:  
 
This is an interesting study aimed to evaluate the re -bleeding rate after CE and the predictive 
factors associated with re -bleeding in OGIB patients in long -term follow -up. 
 
 
Comments:  
 
1. Small sample size. Only 134 patients were included in the analysis and out of the 134 
patients, only 58 (43%) were CE positive (P2 lesion). Eight patients had P1 lesion and 68 
patient s had P0 lesion. The small number of patients in the 3 different groups hardly can 
show a definitive conclusion.  
 
2. In patients with positive CE, 17 received device assisted Enteroscopy. Without any 
specific endoscopic treatment DAE should be considered a diagnostic procedure. Please 
specify which type of treatment was performed during DAE and which type of lesion was 
treated.  
 
3. Please specify which type of medication treatment was performed and for which type of 
lesions.  
 
4. In the group of positive findi ngs on the initial CE, there are 2 cases of tumor (cancer of 
the appendix and gastrointestinal stromal tumor). Please specify why these 2 patients did 
not receive a specific treatment and were on follow -up.  
 
5. In the group of positive findings on the init ial CE, there are cases of duodenitis and 
ectopic varix. I am not convinced that these cases should be considered in this group. 
Duodenitis is within reach of upper GI endoscopy and it is unclear why it is included in 
obscure gastrointestinal bleeding pati ents. In addition, it is unclear the definition of 
ectopic varix. Is this a case of isolated small bowel phlebectasia? If this is the case, 
usually it should be considered as non relevant (max P1).  
 
6. Considering my previous comments, if we exclude patient s described in my comments 
above (#4 and #5), do we still have any difference between the groups in terms of 
rebleeding?  
 
 
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.  
 
No 
 
Are the conclusions drawn 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 recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
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 
organisati on 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 manuscrip t, 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 co mpeting 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 f or 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 Acc ess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understa nd that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to the open peer review policy of the journal  
 
 
Reviewer ’s report  
 
Title: Re-bleeding and its predictors after capsule end oscopy in patients with obscure 
gastrointestinal bleeding in long -term follow -up 
 
Version: 0 Date: 10 Jul 2019  
 
Reviewer: Cristiano Spada  
 
Reviewer's report:  
 
This is an interesting study aimed to evaluate the re -bleeding rate after CE and the predictive 
factors associated with re -bleeding in OGIB patients in long -term follow -up. 
 
 
Comments:  
 
1. Small sample size. Only 134 patients were included in the analysis and out of the 134 
patients, only 58 (43%) were CE positive (P2 lesion). Eight patients had P1 lesion and 68 
patient s had P0 lesion. The small number of patients in the 3 different groups hardly can 
show a definitive conclusion.  
 
2. In patients with positive CE, 17 received device assisted Enteroscopy. Without any 
specific endoscopic treatment DAE should be considered a diagnostic procedure. Please 
specify which type of treatment was performed during DAE and which type of lesion was 
treated.  
 
3. Please specify which type of medication treatment was performed and for which type of 
lesions.  
 
4. In the group of positive findi ngs on the initial CE, there are 2 cases of tumor (cancer of 
the appendix and gastrointestinal stromal tumor). Please specify why these 2 patients did 
not receive a specific treatment and were on follow -up.  
 
5. In the group of positive findings on the init ial CE, there are cases of duodenitis and 
ectopic varix. I am not convinced that these cases should be considered in this group. 
Duodenitis is within reach of upper GI endoscopy and it is unclear why it is included in 
obscure gastrointestinal bleeding pati ents. In addition, it is unclear the definition of 
ectopic varix. Is this a case of isolated small bowel phlebectasia? If this is the case, 
usually it should be considered as non relevant (max P1).  
 
6. Considering my previous comments, if we exclude patient s described in my comments 
above (#4 and #5), do we still have any difference between the groups in terms of 
rebleeding?  
 
 
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.  
 
No 
 
Are the conclusions drawn 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 recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
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 
organisati on 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 manuscrip t, 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 co mpeting 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 f or 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 Acc ess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understa nd that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editor s, 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: Re-bleeding and its predictors after capsule end oscopy in patients with obscure 
gastrointestinal bleeding in long -term follow -up 
 
Version: 0 Date: 10 Jul 2019  
 
Reviewer: Cristiano Spada  
 
Reviewer's report:  
 
This is an interesting study aimed to evaluate the re -bleeding rate after CE and the predictive 
factors associated with re -bleeding in OGIB patients in long -term follow -up. 
 
 
Comments:  
 
1. Small sample size. Only 134 patients were included in the analysis and out of the 134 
patients, only 58 (43%) were CE positive (P2 lesion). Eight patients had P1 lesion and 68 
patient s had P0 lesion. The small number of patients in the 3 different groups hardly can 
show a definitive conclusion.  
 
2. In patients with positive CE, 17 received device assisted Enteroscopy. Without any 
specific endoscopic treatment DAE should be considered a diagnostic procedure. Please 
specify which type of treatment was performed during DAE and which type of lesion was 
treated.  
 
3. Please specify which type of medication treatment was performed and for which type of 
lesions.  
 
4. In the group of positive findi ngs on the initial CE, there are 2 cases of tumor (cancer of 
the appendix and gastrointestinal stromal tumor). Please specify why these 2 patients did 
not receive a specific treatment and were on follow -up.  
 
5. In the group of positive findings on the init ial CE, there are cases of duodenitis and 
ectopic varix. I am not convinced that these cases should be considered in this group. 
Duodenitis is within reach of upper GI endoscopy and it is unclear why it is included in 
obscure gastrointestinal bleeding pati ents. In addition, it is unclear the definition of 
ectopic varix. Is this a case of isolated small bowel phlebectasia? If this is the case, 
usually it should be considered as non relevant (max P1).  
 
6. Considering my previous comments, if we exclude patient s described in my comments 
above (#4 and #5), do we still have any difference between the groups in terms of 
rebleeding?  
 
 
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.  
 
No 
 
Are the conclusions drawn 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 recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
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 
organisati on 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 manuscrip t, 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 co mpeting 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 f or 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 Acc ess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understa nd that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to the open peer review policy of the journal  
 
 
assistant