Title: Impact of timing of endoscopy on clinical outcomes in cirrhotic patients with esophageal
variceal bleeding: a monocentric retrospective study from Vietnam
Version: 2 Date: 18 Apr 2025
Reviewer's report:
Comments on the manuscript by Khoa Nguyen Phuoc et al.
The authors investigated the impact of endoscopy timing on clinical outcomes in patients
presenting with gastrointestinal bleeding due to esophageal varices. The study excluded non-
esophageal bleeding. The study concludes that there is no statistically significant difference
in outcomes between early and delayed endoscopy. This topic has been addressed in several
retrospective and RCT studies.
Major Comments:
-Study Design: The retrospective, single-center nature of the study is a limitation and may affect
the generalizability of the findings.
-Authors need to specify how many patients in the cohort experienced renal injury, as this is a
relevant clinical factor that may influence outcomes.
- Authors need to add a decrease in hemoglobin concentration/ blood transfusion to the main
outcomes as not all cases require blood transfusion.
- Table 3: The authors are advised to include Child-Pugh Class C as a variable in the multivariate
logistic regression model assessing in-hospital mortality. This is a well-established predictor of
poor outcomes and should be accounted for.
-Table 3: Authors need to add endoscopic intervention or surgery and days of hospital admission
(# 5 days) to the logistic regression.
-The incidence of rebleeding during hospitalization or after should be reported as a main
outcome.
Title: Impact of timing of endoscopy on clinical outcomes in cirrhotic patients with esophageal
variceal bleeding: a monocentric retrospective study from Vietnam
Version: 2 Date: 18 Apr 2025
Reviewer's report:
Comments on the manuscript by Khoa Nguyen Phuoc et al.
The authors investigated the impact of endoscopy timing on clinical outcomes in patients
presenting with gastrointestinal bleeding due to esophageal varices. The study excluded non-
esophageal bleeding. The study concludes that there is no statistically significant difference
in outcomes between early and delayed endoscopy. This topic has been addressed in several
retrospective and RCT studies.
Major Comments:
-Study Design: The retrospective, single-center nature of the study is a limitation and may affect
the generalizability of the findings.
-Authors need to specify how many patients in the cohort experienced renal injury, as this is a
relevant clinical factor that may influence outcomes.
- Authors need to add a decrease in hemoglobin concentration/ blood transfusion to the main
outcomes as not all cases require blood transfusion.
- Table 3: The authors are advised to include Child-Pugh Class C as a variable in the multivariate
logistic regression model assessing in-hospital mortality. This is a well-established predictor of
poor outcomes and should be accounted for.
-Table 3: Authors need to add endoscopic intervention or surgery and days of hospital admission
(# 5 days) to the logistic regression.
-The incidence of rebleeding during hospitalization or after should be reported as a main
outcome.
Please review this paper.
user
Title: Impact of timing of endoscopy on clinical outcomes in cirrhotic patients with esophageal
variceal bleeding: a monocentric retrospective study from Vietnam
Version: 2 Date: 18 Apr 2025
Reviewer's report:
Comments on the manuscript by Khoa Nguyen Phuoc et al.
The authors investigated the impact of endoscopy timing on clinical outcomes in patients
presenting with gastrointestinal bleeding due to esophageal varices. The study excluded non-
esophageal bleeding. The study concludes that there is no statistically significant difference
in outcomes between early and delayed endoscopy. This topic has been addressed in several
retrospective and RCT studies.
Major Comments:
-Study Design: The retrospective, single-center nature of the study is a limitation and may affect
the generalizability of the findings.
-Authors need to specify how many patients in the cohort experienced renal injury, as this is a
relevant clinical factor that may influence outcomes.
- Authors need to add a decrease in hemoglobin concentration/ blood transfusion to the main
outcomes as not all cases require blood transfusion.
- Table 3: The authors are advised to include Child-Pugh Class C as a variable in the multivariate
logistic regression model assessing in-hospital mortality. This is a well-established predictor of
poor outcomes and should be accounted for.
-Table 3: Authors need to add endoscopic intervention or surgery and days of hospital admission
(# 5 days) to the logistic regression.
-The incidence of rebleeding during hospitalization or after should be reported as a main
outcome.
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