Title: Outcomes of endoscopic submucosal dissection for gastroesophageal reflux disease
(ESD-G) for medication-refractory gastroesophageal reflux disease: 35 cases underwent ESD-
G including 15 cases followed more than 5 years.
Version: 1 Date: 20 Aug 2021
Reviewer:  Shiko Kuribayashi
Reviewer's report:
Summary
“Long-term outcomes of endoscopic submucosal dissection for gastric esophageal reflux disease
for medication-refractory gastroesophageal reflux disease” reported effectiveness of ESD-G for
medication-refractory GERD not only for short term but also for long term. I am impressed by
the challenging treatment, but I have several comments.
Major comments
1. As authors noted, the effects of ESD-G may be a placebo effect. No change of the number
of reflux events after ESD-G and the improvement of dysmotility scores represent the placebo
effect. Authors should confirm the effectiveness of ESD-G with a sham treatment.
2. Since there are too many missing data, results are difficult to be evaluated. Impedance-pH
monitoring was performed in less than half of patients. In addition, long term effects of ESD-G
were evaluated in only less than half of patients, which is the primary outcome of this manuscript.
3. Did you perform impedance-pH monitoring on PPI or off PPI? Moreover, did you perform
esophageal manometry before impedance-pH manometry? Furthermore, how did you locate
esophageal pH sensor without manometry if you did not perform esophageal manometry. How
was esophageal motility in enrolled patients if you perform esophageal manometry? Authors
should describe details about it.
4. What kinds of patients were enrolled in the study? Since impedance-pH monitoring
was performed, patients could be categorized as reflux esophagitis, true NERD, reflux
hypersensitivity or functional heartburn. In addition, were the outcomes of ESD-G among these
patients different?
5. If the strength of the study is long-term outcome, authors should focus on it. If authors want
to discuss both short-term and long-term effects, the relationship between short-term and long-
term should be discussed. Current form of the manuscript is not suitable.
Minor comment
1. “gastric esophageal reflux” in the title should be “gastroesophageal reflux”.
Title: Outcomes of endoscopic submucosal dissection for gastroesophageal reflux disease
(ESD-G) for medication-refractory gastroesophageal reflux disease: 35 cases underwent ESD-
G including 15 cases followed more than 5 years.
Version: 1 Date: 20 Aug 2021
Reviewer:  Shiko Kuribayashi
Reviewer's report:
Summary
“Long-term outcomes of endoscopic submucosal dissection for gastric esophageal reflux disease
for medication-refractory gastroesophageal reflux disease” reported effectiveness of ESD-G for
medication-refractory GERD not only for short term but also for long term. I am impressed by
the challenging treatment, but I have several comments.
Major comments
1. As authors noted, the effects of ESD-G may be a placebo effect. No change of the number
of reflux events after ESD-G and the improvement of dysmotility scores represent the placebo
effect. Authors should confirm the effectiveness of ESD-G with a sham treatment.
2. Since there are too many missing data, results are difficult to be evaluated. Impedance-pH
monitoring was performed in less than half of patients. In addition, long term effects of ESD-G
were evaluated in only less than half of patients, which is the primary outcome of this manuscript.
3. Did you perform impedance-pH monitoring on PPI or off PPI? Moreover, did you perform
esophageal manometry before impedance-pH manometry? Furthermore, how did you locate
esophageal pH sensor without manometry if you did not perform esophageal manometry. How
was esophageal motility in enrolled patients if you perform esophageal manometry? Authors
should describe details about it.
4. What kinds of patients were enrolled in the study? Since impedance-pH monitoring
was performed, patients could be categorized as reflux esophagitis, true NERD, reflux
hypersensitivity or functional heartburn. In addition, were the outcomes of ESD-G among these
patients different?
5. If the strength of the study is long-term outcome, authors should focus on it. If authors want
to discuss both short-term and long-term effects, the relationship between short-term and long-
term should be discussed. Current form of the manuscript is not suitable.
Minor comment
1. “gastric esophageal reflux” in the title should be “gastroesophageal reflux”.
Please review this paper.
user
Title: Outcomes of endoscopic submucosal dissection for gastroesophageal reflux disease
(ESD-G) for medication-refractory gastroesophageal reflux disease: 35 cases underwent ESD-
G including 15 cases followed more than 5 years.
Version: 1 Date: 20 Aug 2021
Reviewer:  Shiko Kuribayashi
Reviewer's report:
Summary
“Long-term outcomes of endoscopic submucosal dissection for gastric esophageal reflux disease
for medication-refractory gastroesophageal reflux disease” reported effectiveness of ESD-G for
medication-refractory GERD not only for short term but also for long term. I am impressed by
the challenging treatment, but I have several comments.
Major comments
1. As authors noted, the effects of ESD-G may be a placebo effect. No change of the number
of reflux events after ESD-G and the improvement of dysmotility scores represent the placebo
effect. Authors should confirm the effectiveness of ESD-G with a sham treatment.
2. Since there are too many missing data, results are difficult to be evaluated. Impedance-pH
monitoring was performed in less than half of patients. In addition, long term effects of ESD-G
were evaluated in only less than half of patients, which is the primary outcome of this manuscript.
3. Did you perform impedance-pH monitoring on PPI or off PPI? Moreover, did you perform
esophageal manometry before impedance-pH manometry? Furthermore, how did you locate
esophageal pH sensor without manometry if you did not perform esophageal manometry. How
was esophageal motility in enrolled patients if you perform esophageal manometry? Authors
should describe details about it.
4. What kinds of patients were enrolled in the study? Since impedance-pH monitoring
was performed, patients could be categorized as reflux esophagitis, true NERD, reflux
hypersensitivity or functional heartburn. In addition, were the outcomes of ESD-G among these
patients different?
5. If the strength of the study is long-term outcome, authors should focus on it. If authors want
to discuss both short-term and long-term effects, the relationship between short-term and long-
term should be discussed. Current form of the manuscript is not suitable.
Minor comment
1. “gastric esophageal reflux” in the title should be “gastroesophageal reflux”.
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