Reviewer ’s report  
 
Title: Over -The-Scope -Clip pre -mounted onto a double balloon enteroscope for fast and 
successful c losure of post -EMR jejunal perforation: case report.  
 
Version: 0 Date: 30 Jun 2017  
 
Reviewer: Raymomd Tang  
 
Reviewer's report:  
 
The authors reported an important and useful technique for prompt management of an usually 
difficult to management situation.  
The title of the case report highlighted the clinical significance of the tec hnique.  
 
I have 3 minor comments / suggestions for the authors:  
1) Please also describe how the tissue specimen was retrieved after successful deployment of 
the OTSC for closure of the perforation because it is important to have tissue diagnosis (to 
rule out high grade dysplasia or early cancer) in this patient with FA P. 
2) Please consider the following edits of the Abstract to better highlight the clinical significance 
of your technique in the management of perforation related to EMR in jejunum:  
- Background: Describe the challenges in the usual management (eg, surgery  vs endoscopic 
management) of adenomatous lesions in duodenum / jejunum in FAP patients, the difficulty 
and risks of EMR for jejunal lesions by DBE  (you have already described that in the 
Conclusion but some of the content is better served to be included in the Background).  
- Case: Please also describe a small perforation was noted after EMR and was successfully 
managed with OTSC pre -mounted on DBE (this is the essence of the report)  
- Conclusion: Consider just saying that the current case demonstrated how OTSC pre -mounted 
on DBE contribute to the efficient management of perforation after EMR in jejunum.    
3) Just out of curiosity, if the jejunal EMR did not result in perforation, how should we justify 
"wasting" the OTSC pre -mounted on the endoscope ? (the  OTSC is quite expensive).  
Are the methods appropriate and well described?  
If not, please specify what is required in your comment s 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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explai n in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessme nt in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing intere sts, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the f uture?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the co ntent 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 h ave 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 competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no comp eting interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be po sted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be in cluded in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Over -The-Scope -Clip pre -mounted onto a double balloon enteroscope for fast and 
successful c losure of post -EMR jejunal perforation: case report.  
 
Version: 0 Date: 30 Jun 2017  
 
Reviewer: Raymomd Tang  
 
Reviewer's report:  
 
The authors reported an important and useful technique for prompt management of an usually 
difficult to management situation.  
The title of the case report highlighted the clinical significance of the tec hnique.  
 
I have 3 minor comments / suggestions for the authors:  
1) Please also describe how the tissue specimen was retrieved after successful deployment of 
the OTSC for closure of the perforation because it is important to have tissue diagnosis (to 
rule out high grade dysplasia or early cancer) in this patient with FA P. 
2) Please consider the following edits of the Abstract to better highlight the clinical significance 
of your technique in the management of perforation related to EMR in jejunum:  
- Background: Describe the challenges in the usual management (eg, surgery  vs endoscopic 
management) of adenomatous lesions in duodenum / jejunum in FAP patients, the difficulty 
and risks of EMR for jejunal lesions by DBE  (you have already described that in the 
Conclusion but some of the content is better served to be included in the Background).  
- Case: Please also describe a small perforation was noted after EMR and was successfully 
managed with OTSC pre -mounted on DBE (this is the essence of the report)  
- Conclusion: Consider just saying that the current case demonstrated how OTSC pre -mounted 
on DBE contribute to the efficient management of perforation after EMR in jejunum.    
3) Just out of curiosity, if the jejunal EMR did not result in perforation, how should we justify 
"wasting" the OTSC pre -mounted on the endoscope ? (the  OTSC is quite expensive).  
Are the methods appropriate and well described?  
If not, please specify what is required in your comment s 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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explai n in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessme nt in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing intere sts, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the f uture?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the co ntent 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 h ave 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 competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no comp eting interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be po sted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be in cluded in my named report can be included as confidential comments  
to the editors, 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: Over -The-Scope -Clip pre -mounted onto a double balloon enteroscope for fast and 
successful c losure of post -EMR jejunal perforation: case report.  
 
Version: 0 Date: 30 Jun 2017  
 
Reviewer: Raymomd Tang  
 
Reviewer's report:  
 
The authors reported an important and useful technique for prompt management of an usually 
difficult to management situation.  
The title of the case report highlighted the clinical significance of the tec hnique.  
 
I have 3 minor comments / suggestions for the authors:  
1) Please also describe how the tissue specimen was retrieved after successful deployment of 
the OTSC for closure of the perforation because it is important to have tissue diagnosis (to 
rule out high grade dysplasia or early cancer) in this patient with FA P. 
2) Please consider the following edits of the Abstract to better highlight the clinical significance 
of your technique in the management of perforation related to EMR in jejunum:  
- Background: Describe the challenges in the usual management (eg, surgery  vs endoscopic 
management) of adenomatous lesions in duodenum / jejunum in FAP patients, the difficulty 
and risks of EMR for jejunal lesions by DBE  (you have already described that in the 
Conclusion but some of the content is better served to be included in the Background).  
- Case: Please also describe a small perforation was noted after EMR and was successfully 
managed with OTSC pre -mounted on DBE (this is the essence of the report)  
- Conclusion: Consider just saying that the current case demonstrated how OTSC pre -mounted 
on DBE contribute to the efficient management of perforation after EMR in jejunum.    
3) Just out of curiosity, if the jejunal EMR did not result in perforation, how should we justify 
"wasting" the OTSC pre -mounted on the endoscope ? (the  OTSC is quite expensive).  
Are the methods appropriate and well described?  
If not, please specify what is required in your comment s 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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explai n in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessme nt in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing intere sts, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the f uture?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the co ntent 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 h ave 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 competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no comp eting interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be po sted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be in cluded in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant