Title: Unraveling the Site-Specific Features in Small Intestinal Stromal Tumors: A
Retrospective Study
Version: 2 Date: 04 Mar 2025
Reviewer:  Ryosuke Sato
Reviewer's report:
Thank you for allowing me to review this thoroughly researched paper on small intestinal GISTs.
This is a retrospective study to enhance the understanding of the clinical characteristics and
disease behavior of small intestinal GISTs based on their sites.  Following are my comments
for this manuscript.
Introduction:
In previous studies, small intestinal GIST exhibited a higher rate of lymph node metastasis
compared to gastric GISTs, however, only one case showed lymph node metastasis in this study.
Reference #8 also stated that the lymph node metastasis rate for small intestine GIST was around
10%, but what is the cause of this difference?
Methods:
Patients who were diagnosed as GIST based on immunohistochemical findings were included in
this study.  Patients who were diagnosed as GIST based on immunohistochemical findings were
included in this study. What was the immunohistochemical profiling of these patients? Were all
patients positive for c-kit? Was anyone positive for CD-34 or DOG-1?
Results:
Tumor rupture is the major symptom affecting the prognosis of patients with GISTs. Did anyone
undergo emergency surgery because of tumor rupture?
What led to the patient being diagnosed with GISTs, and what was the modality used for
diagnosing, for example, CT, MRI, EGD, balloon-assisted enteroscopy, capsule endoscopy, or
abdominal US?
Patients for familial GIST or neurofibromatosis type 1 often present multiple GISTs. Was
anyone with a hereditary disease in this study? Any multiple GISTs?
Discussion:
You mentioned, "The higher rate of bleeding in the jejunum is likely because it has the richest
blood supply in the small intestine.". Please provide references.
It seems that the tumor characteristics of jejunal GISTs and ileal GISTs are almost the same.
Please summarize in an easy-to-understand way the reasons why it is better to distinguish
between them and when to suspect them based on the symptoms that appear.
Title: Unraveling the Site-Specific Features in Small Intestinal Stromal Tumors: A
Retrospective Study
Version: 2 Date: 04 Mar 2025
Reviewer:  Ryosuke Sato
Reviewer's report:
Thank you for allowing me to review this thoroughly researched paper on small intestinal GISTs.
This is a retrospective study to enhance the understanding of the clinical characteristics and
disease behavior of small intestinal GISTs based on their sites.  Following are my comments
for this manuscript.
Introduction:
In previous studies, small intestinal GIST exhibited a higher rate of lymph node metastasis
compared to gastric GISTs, however, only one case showed lymph node metastasis in this study.
Reference #8 also stated that the lymph node metastasis rate for small intestine GIST was around
10%, but what is the cause of this difference?
Methods:
Patients who were diagnosed as GIST based on immunohistochemical findings were included in
this study.  Patients who were diagnosed as GIST based on immunohistochemical findings were
included in this study. What was the immunohistochemical profiling of these patients? Were all
patients positive for c-kit? Was anyone positive for CD-34 or DOG-1?
Results:
Tumor rupture is the major symptom affecting the prognosis of patients with GISTs. Did anyone
undergo emergency surgery because of tumor rupture?
What led to the patient being diagnosed with GISTs, and what was the modality used for
diagnosing, for example, CT, MRI, EGD, balloon-assisted enteroscopy, capsule endoscopy, or
abdominal US?
Patients for familial GIST or neurofibromatosis type 1 often present multiple GISTs. Was
anyone with a hereditary disease in this study? Any multiple GISTs?
Discussion:
You mentioned, "The higher rate of bleeding in the jejunum is likely because it has the richest
blood supply in the small intestine.". Please provide references.
It seems that the tumor characteristics of jejunal GISTs and ileal GISTs are almost the same.
Please summarize in an easy-to-understand way the reasons why it is better to distinguish
between them and when to suspect them based on the symptoms that appear.
Please review this paper.
user
Title: Unraveling the Site-Specific Features in Small Intestinal Stromal Tumors: A
Retrospective Study
Version: 2 Date: 04 Mar 2025
Reviewer:  Ryosuke Sato
Reviewer's report:
Thank you for allowing me to review this thoroughly researched paper on small intestinal GISTs.
This is a retrospective study to enhance the understanding of the clinical characteristics and
disease behavior of small intestinal GISTs based on their sites.  Following are my comments
for this manuscript.
Introduction:
In previous studies, small intestinal GIST exhibited a higher rate of lymph node metastasis
compared to gastric GISTs, however, only one case showed lymph node metastasis in this study.
Reference #8 also stated that the lymph node metastasis rate for small intestine GIST was around
10%, but what is the cause of this difference?
Methods:
Patients who were diagnosed as GIST based on immunohistochemical findings were included in
this study.  Patients who were diagnosed as GIST based on immunohistochemical findings were
included in this study. What was the immunohistochemical profiling of these patients? Were all
patients positive for c-kit? Was anyone positive for CD-34 or DOG-1?
Results:
Tumor rupture is the major symptom affecting the prognosis of patients with GISTs. Did anyone
undergo emergency surgery because of tumor rupture?
What led to the patient being diagnosed with GISTs, and what was the modality used for
diagnosing, for example, CT, MRI, EGD, balloon-assisted enteroscopy, capsule endoscopy, or
abdominal US?
Patients for familial GIST or neurofibromatosis type 1 often present multiple GISTs. Was
anyone with a hereditary disease in this study? Any multiple GISTs?
Discussion:
You mentioned, "The higher rate of bleeding in the jejunum is likely because it has the richest
blood supply in the small intestine.". Please provide references.
It seems that the tumor characteristics of jejunal GISTs and ileal GISTs are almost the same.
Please summarize in an easy-to-understand way the reasons why it is better to distinguish
between them and when to suspect them based on the symptoms that appear.
assistant