Reviewer ’s report  
 
Title: A combination of single -balloon enteroscopy -assisted lap aroscopy and endoscopic 
mucosal resection for treating gastrointestinal venous malformations in b lue rubber bleb nevus 
syndrome: A case report  
 
Version: 0 Date: 25 Mar 2020  
 
Reviewer: Yuichiro Kuroki  
 
Reviewer's report:  
 
This paper describes a case of appropriate management for gastrointestinal venous 
malformations in blue rubber bleb nevus syndr ome, especially focused on the endoscopic images 
and treatment. The case shown in the paper is rare and clinically interesting. However, the 
authors should address the following points.  
 
 
1. The small intestinal lesions had been surgically resected, but the  usefulness of balloon -assisted 
enteroscopy in this manuscript is not clear. The authors should describe the specific usefulness of 
the balloon -assisted enteroscopy.  
 
（What is the usefulness of balloon assisted enteroscopy? Marking lesions with tattoos or c lips 
before surgery, or identifying lesions directly using intraoperative endoscopes to support 
laparoscopic surgery? ） 
 
 
2. The photographs (Fig1 a, c) of the stomach and small intestine capsules are acceptable, but 
you should replace the photos （Fig1b）of th e descending colon because the lesions are difficult 
to see. In addition, you should consider including 6 months follow -up photographs after 
endoscopic resection for clear usefulness of treatment.  
 
 
3. The image quality of the photographs should be correcte d in Fig 2(d, e).  
 
 
4. As it may be difficult to estimate BRBNS by only Fig 3, I recommend that the authors add or 
change to the other photographs. Please the authors refer to following articles on histological 
findings (figure) of BRBNS.  
 
(Example 1: Heman giomas confined to submucosa  
 
Shimada S, Namikawa K, Maeda K, Obata S, Ikei S, Mizutani J, Ogawa M. Endoscopic 
polypectomy under laparotomy throughout the alimentary tract for a patient with Blue Rubber 
Bleb Nevus Syndrome.  Gastrointest Endosc. 1997; 45 42 3-427 
Example 2: Histologic appearance of a colonic polyp showing a cavernous hemangioma 
compatible with blue rubber bleb nevus syndrome  
 
Bak Y T, Oh C H, Kim J H, Lee C H. Blue Rubber Bleb Nevus Syndrome: endoscopic removal 
of the gastrointestinal hemangio mas.  Gastrointest Endosc. 1997; 45 90 -92) 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments 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 explain in your comments to the authors.  
 
No 
 
Are you able to assess any sta tistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment 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 interests, considering the following questions:  
 
1.  Have you in the past five years  received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation that may in an y 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 content 
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 have 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 competing interests.  
 
I agree to the open  peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the a uthors' 
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 included in my named report can be inc luded 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: A combination of single -balloon enteroscopy -assisted lap aroscopy and endoscopic 
mucosal resection for treating gastrointestinal venous malformations in b lue rubber bleb nevus 
syndrome: A case report  
 
Version: 0 Date: 25 Mar 2020  
 
Reviewer: Yuichiro Kuroki  
 
Reviewer's report:  
 
This paper describes a case of appropriate management for gastrointestinal venous 
malformations in blue rubber bleb nevus syndr ome, especially focused on the endoscopic images 
and treatment. The case shown in the paper is rare and clinically interesting. However, the 
authors should address the following points.  
 
 
1. The small intestinal lesions had been surgically resected, but the  usefulness of balloon -assisted 
enteroscopy in this manuscript is not clear. The authors should describe the specific usefulness of 
the balloon -assisted enteroscopy.  
 
（What is the usefulness of balloon assisted enteroscopy? Marking lesions with tattoos or c lips 
before surgery, or identifying lesions directly using intraoperative endoscopes to support 
laparoscopic surgery? ） 
 
 
2. The photographs (Fig1 a, c) of the stomach and small intestine capsules are acceptable, but 
you should replace the photos （Fig1b）of th e descending colon because the lesions are difficult 
to see. In addition, you should consider including 6 months follow -up photographs after 
endoscopic resection for clear usefulness of treatment.  
 
 
3. The image quality of the photographs should be correcte d in Fig 2(d, e).  
 
 
4. As it may be difficult to estimate BRBNS by only Fig 3, I recommend that the authors add or 
change to the other photographs. Please the authors refer to following articles on histological 
findings (figure) of BRBNS.  
 
(Example 1: Heman giomas confined to submucosa  
 
Shimada S, Namikawa K, Maeda K, Obata S, Ikei S, Mizutani J, Ogawa M. Endoscopic 
polypectomy under laparotomy throughout the alimentary tract for a patient with Blue Rubber 
Bleb Nevus Syndrome.  Gastrointest Endosc. 1997; 45 42 3-427 
Example 2: Histologic appearance of a colonic polyp showing a cavernous hemangioma 
compatible with blue rubber bleb nevus syndrome  
 
Bak Y T, Oh C H, Kim J H, Lee C H. Blue Rubber Bleb Nevus Syndrome: endoscopic removal 
of the gastrointestinal hemangio mas.  Gastrointest Endosc. 1997; 45 90 -92) 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments 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 explain in your comments to the authors.  
 
No 
 
Are you able to assess any sta tistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment 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 interests, considering the following questions:  
 
1.  Have you in the past five years  received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation that may in an y 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 content 
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 have 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 competing interests.  
 
I agree to the open  peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the a uthors' 
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 included in my named report can be inc luded 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: A combination of single -balloon enteroscopy -assisted lap aroscopy and endoscopic 
mucosal resection for treating gastrointestinal venous malformations in b lue rubber bleb nevus 
syndrome: A case report  
 
Version: 0 Date: 25 Mar 2020  
 
Reviewer: Yuichiro Kuroki  
 
Reviewer's report:  
 
This paper describes a case of appropriate management for gastrointestinal venous 
malformations in blue rubber bleb nevus syndr ome, especially focused on the endoscopic images 
and treatment. The case shown in the paper is rare and clinically interesting. However, the 
authors should address the following points.  
 
 
1. The small intestinal lesions had been surgically resected, but the  usefulness of balloon -assisted 
enteroscopy in this manuscript is not clear. The authors should describe the specific usefulness of 
the balloon -assisted enteroscopy.  
 
（What is the usefulness of balloon assisted enteroscopy? Marking lesions with tattoos or c lips 
before surgery, or identifying lesions directly using intraoperative endoscopes to support 
laparoscopic surgery? ） 
 
 
2. The photographs (Fig1 a, c) of the stomach and small intestine capsules are acceptable, but 
you should replace the photos （Fig1b）of th e descending colon because the lesions are difficult 
to see. In addition, you should consider including 6 months follow -up photographs after 
endoscopic resection for clear usefulness of treatment.  
 
 
3. The image quality of the photographs should be correcte d in Fig 2(d, e).  
 
 
4. As it may be difficult to estimate BRBNS by only Fig 3, I recommend that the authors add or 
change to the other photographs. Please the authors refer to following articles on histological 
findings (figure) of BRBNS.  
 
(Example 1: Heman giomas confined to submucosa  
 
Shimada S, Namikawa K, Maeda K, Obata S, Ikei S, Mizutani J, Ogawa M. Endoscopic 
polypectomy under laparotomy throughout the alimentary tract for a patient with Blue Rubber 
Bleb Nevus Syndrome.  Gastrointest Endosc. 1997; 45 42 3-427 
Example 2: Histologic appearance of a colonic polyp showing a cavernous hemangioma 
compatible with blue rubber bleb nevus syndrome  
 
Bak Y T, Oh C H, Kim J H, Lee C H. Blue Rubber Bleb Nevus Syndrome: endoscopic removal 
of the gastrointestinal hemangio mas.  Gastrointest Endosc. 1997; 45 90 -92) 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments 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 explain in your comments to the authors.  
 
No 
 
Are you able to assess any sta tistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment 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 interests, considering the following questions:  
 
1.  Have you in the past five years  received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation that may in an y 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 content 
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 have 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 competing interests.  
 
I agree to the open  peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the a uthors' 
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 included in my named report can be inc luded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant