Title: Nomogram for predicting rebleeding after initial endoscopic epinephrine injection
monotherapy hemostasis in patients with peptic ulcer bleeding: a retrospective cohort study
Version: 1 Date: 02 Jul 2022
Reviewer:  Daisuke Yamaguchi
Reviewer's report:
This paper is an interesting paper that shows a nomogram for predicting rebleeding after initial
endoscopic epinephrine injection monotherapy hemostasis in patients with peptic ulcer bleeding.
Although it is a clinical and interesting paper, I have some comments.
1. As stated by the investigator, many authoritative guidelines recommend combination therapy
using epinephrine injection plus a second hemostasis modality (contact thermal or mechanical
therapy) for patients with actively bleeding ulcers. Epinephrine monotherapy is a treatment of
the past, and the abstract of this paper is generally not advisable. Instead, the investigator should
highlight the risks of epinephrine monotherapy.
2. The exclusion of patients treated with epinephrine combination therapy is a selection bias
of endoscopists in the exclusion criteria. Peptic ulcer patients at high risk of rebleeding were
excluded from the study, so the data cannot be considered accurate. Prospective studies should
be conducted, as retrospective studies have limitations.
3. 25.5% of patients with rebleeding died, which is considered a high rate. Predictive
nomographs on death should also be considered.
4. Please add details of the endoscopist specialists and trainees involved in the study.
5. Please provide endoscopic findings of standard epinephrine monotherapy in Fig.
I hope these comments will be helpful.
Title: Nomogram for predicting rebleeding after initial endoscopic epinephrine injection
monotherapy hemostasis in patients with peptic ulcer bleeding: a retrospective cohort study
Version: 1 Date: 02 Jul 2022
Reviewer:  Daisuke Yamaguchi
Reviewer's report:
This paper is an interesting paper that shows a nomogram for predicting rebleeding after initial
endoscopic epinephrine injection monotherapy hemostasis in patients with peptic ulcer bleeding.
Although it is a clinical and interesting paper, I have some comments.
1. As stated by the investigator, many authoritative guidelines recommend combination therapy
using epinephrine injection plus a second hemostasis modality (contact thermal or mechanical
therapy) for patients with actively bleeding ulcers. Epinephrine monotherapy is a treatment of
the past, and the abstract of this paper is generally not advisable. Instead, the investigator should
highlight the risks of epinephrine monotherapy.
2. The exclusion of patients treated with epinephrine combination therapy is a selection bias
of endoscopists in the exclusion criteria. Peptic ulcer patients at high risk of rebleeding were
excluded from the study, so the data cannot be considered accurate. Prospective studies should
be conducted, as retrospective studies have limitations.
3. 25.5% of patients with rebleeding died, which is considered a high rate. Predictive
nomographs on death should also be considered.
4. Please add details of the endoscopist specialists and trainees involved in the study.
5. Please provide endoscopic findings of standard epinephrine monotherapy in Fig.
I hope these comments will be helpful.
Please review this paper.
user
Title: Nomogram for predicting rebleeding after initial endoscopic epinephrine injection
monotherapy hemostasis in patients with peptic ulcer bleeding: a retrospective cohort study
Version: 1 Date: 02 Jul 2022
Reviewer:  Daisuke Yamaguchi
Reviewer's report:
This paper is an interesting paper that shows a nomogram for predicting rebleeding after initial
endoscopic epinephrine injection monotherapy hemostasis in patients with peptic ulcer bleeding.
Although it is a clinical and interesting paper, I have some comments.
1. As stated by the investigator, many authoritative guidelines recommend combination therapy
using epinephrine injection plus a second hemostasis modality (contact thermal or mechanical
therapy) for patients with actively bleeding ulcers. Epinephrine monotherapy is a treatment of
the past, and the abstract of this paper is generally not advisable. Instead, the investigator should
highlight the risks of epinephrine monotherapy.
2. The exclusion of patients treated with epinephrine combination therapy is a selection bias
of endoscopists in the exclusion criteria. Peptic ulcer patients at high risk of rebleeding were
excluded from the study, so the data cannot be considered accurate. Prospective studies should
be conducted, as retrospective studies have limitations.
3. 25.5% of patients with rebleeding died, which is considered a high rate. Predictive
nomographs on death should also be considered.
4. Please add details of the endoscopist specialists and trainees involved in the study.
5. Please provide endoscopic findings of standard epinephrine monotherapy in Fig.
I hope these comments will be helpful.
assistant