Title: Hepatic venous pressure gradient after balloon-occluded retrograde transvenous
obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices
Version: 1 Date: 20 Nov 2022
Reviewer's report:
In this manuscript, Yuki Shirane et al. showed that post-HVPG of #13 mmHg and high level of
serum aspartate aminotransferase were significant independent risk factors for EV exacerbation
after B-RTO. They also showed that elevated liver stiffness measurement (LSM) of #21 kPa
was a significant independent risk factor for poor prognosis after B-RTO.
There is no disputing that this study is a very interesting. However, as noted in the limitation,
the biggest concern in this study is the small sample size and the very large number of cases
that deviated during the observation period, especially with regards to the EV exacerbation rate.
Since the rate decreased to 22.2% (8/36) of all cases within 2 years of observation, the results
cannot be said to be supported by definite evidence. Therefore, unfortunately, we consider it
difficult to accept about this manuscript.
In addition, please refer to the following three points.
1. Table 1: Existence of large portosystemic shunt was 23.5%, which is low in this cohort
that underwent B-RTO in this study. Therefore, the explanation of the definition of large
portosystemic shunt is necessary.
2. The stage of hepatocellular carcinoma and the presence or absence of portal vein tumor
thrombosis should be evaluated as they may influence the results of this study.
3. Are there any cases in which partial splenic embolization (PSE) was performed along with
B-RTO? Since the number of cases treated with the two therapies in combination has been
increasing recently, it is recommended that if there are any cases of combined PSE, they should
be analyzed, and if there are no PSE cases, it is recommended that they be noted.
Title: Hepatic venous pressure gradient after balloon-occluded retrograde transvenous
obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices
Version: 1 Date: 20 Nov 2022
Reviewer's report:
In this manuscript, Yuki Shirane et al. showed that post-HVPG of #13 mmHg and high level of
serum aspartate aminotransferase were significant independent risk factors for EV exacerbation
after B-RTO. They also showed that elevated liver stiffness measurement (LSM) of #21 kPa
was a significant independent risk factor for poor prognosis after B-RTO.
There is no disputing that this study is a very interesting. However, as noted in the limitation,
the biggest concern in this study is the small sample size and the very large number of cases
that deviated during the observation period, especially with regards to the EV exacerbation rate.
Since the rate decreased to 22.2% (8/36) of all cases within 2 years of observation, the results
cannot be said to be supported by definite evidence. Therefore, unfortunately, we consider it
difficult to accept about this manuscript.
In addition, please refer to the following three points.
1. Table 1: Existence of large portosystemic shunt was 23.5%, which is low in this cohort
that underwent B-RTO in this study. Therefore, the explanation of the definition of large
portosystemic shunt is necessary.
2. The stage of hepatocellular carcinoma and the presence or absence of portal vein tumor
thrombosis should be evaluated as they may influence the results of this study.
3. Are there any cases in which partial splenic embolization (PSE) was performed along with
B-RTO? Since the number of cases treated with the two therapies in combination has been
increasing recently, it is recommended that if there are any cases of combined PSE, they should
be analyzed, and if there are no PSE cases, it is recommended that they be noted.
Please review this paper.
user
Title: Hepatic venous pressure gradient after balloon-occluded retrograde transvenous
obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices
Version: 1 Date: 20 Nov 2022
Reviewer's report:
In this manuscript, Yuki Shirane et al. showed that post-HVPG of #13 mmHg and high level of
serum aspartate aminotransferase were significant independent risk factors for EV exacerbation
after B-RTO. They also showed that elevated liver stiffness measurement (LSM) of #21 kPa
was a significant independent risk factor for poor prognosis after B-RTO.
There is no disputing that this study is a very interesting. However, as noted in the limitation,
the biggest concern in this study is the small sample size and the very large number of cases
that deviated during the observation period, especially with regards to the EV exacerbation rate.
Since the rate decreased to 22.2% (8/36) of all cases within 2 years of observation, the results
cannot be said to be supported by definite evidence. Therefore, unfortunately, we consider it
difficult to accept about this manuscript.
In addition, please refer to the following three points.
1. Table 1: Existence of large portosystemic shunt was 23.5%, which is low in this cohort
that underwent B-RTO in this study. Therefore, the explanation of the definition of large
portosystemic shunt is necessary.
2. The stage of hepatocellular carcinoma and the presence or absence of portal vein tumor
thrombosis should be evaluated as they may influence the results of this study.
3. Are there any cases in which partial splenic embolization (PSE) was performed along with
B-RTO? Since the number of cases treated with the two therapies in combination has been
increasing recently, it is recommended that if there are any cases of combined PSE, they should
be analyzed, and if there are no PSE cases, it is recommended that they be noted.
assistant