Title: Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal
bleeding: Propensity score matching analysis of real-world data from Thailand
Version: 3 Date: 11 Sep 2024
Reviewer's report:
Comments
Chang et al. present a paper regarding the impact of timing of upper gastrointestinal endoscopy
(UGIE) in patients with nonvariceal UGI bleed. It is a propensity score matched analysis of
large number of patients divided into two groups i.e., early (UGIE within 24 hrs of presentation)
vs. late (after 24 hrs). The authors found that after adjusting for potential confounders, early
UGIE was associated with finding high risk stigmata and requirement of hemostatic procedures
and was negatively associated with need for PRBCs transfusion and duration of hospital
stay. However, hard endpoints such as in-hospital mortality, rebleeding, requirement of rescue
surgery or radiological procedures and the admission cost was not different between the two
groups.
Pro - This is a propensity score matched (PSM) study (rightly stating that RCTs would be
unethical considering the varying severity of presentation of this potentially life-threatening
condition). The sample size is also large. Conclusions have been drawned after adjusting for
confounders.
Cons –
Major issue - Smoking is an important cause of ulcer bleed. There is no mention whether it was
equally distributed in the two groups.
Minor issues -
1. Caliper distance for PSM is not mentioned.
2. Page 6 line 188 – In the endoscopic diagnosis and outcome of results section, admission cost
of the late endoscopy group is not in line with what is mentioned in the Table 2.
3. In the conclusion section of the abstract, making a strong statement for early endoscopy as
“recommended” will be too much as I consider the hard endpoints as mentioned by me above
more important. It can be changed to “suggestion” or “supports” as mentioned in the conclusion
at the end of the paper.
Title: Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal
bleeding: Propensity score matching analysis of real-world data from Thailand
Version: 3 Date: 11 Sep 2024
Reviewer's report:
Comments
Chang et al. present a paper regarding the impact of timing of upper gastrointestinal endoscopy
(UGIE) in patients with nonvariceal UGI bleed. It is a propensity score matched analysis of
large number of patients divided into two groups i.e., early (UGIE within 24 hrs of presentation)
vs. late (after 24 hrs). The authors found that after adjusting for potential confounders, early
UGIE was associated with finding high risk stigmata and requirement of hemostatic procedures
and was negatively associated with need for PRBCs transfusion and duration of hospital
stay. However, hard endpoints such as in-hospital mortality, rebleeding, requirement of rescue
surgery or radiological procedures and the admission cost was not different between the two
groups.
Pro - This is a propensity score matched (PSM) study (rightly stating that RCTs would be
unethical considering the varying severity of presentation of this potentially life-threatening
condition). The sample size is also large. Conclusions have been drawned after adjusting for
confounders.
Cons –
Major issue - Smoking is an important cause of ulcer bleed. There is no mention whether it was
equally distributed in the two groups.
Minor issues -
1. Caliper distance for PSM is not mentioned.
2. Page 6 line 188 – In the endoscopic diagnosis and outcome of results section, admission cost
of the late endoscopy group is not in line with what is mentioned in the Table 2.
3. In the conclusion section of the abstract, making a strong statement for early endoscopy as
“recommended” will be too much as I consider the hard endpoints as mentioned by me above
more important. It can be changed to “suggestion” or “supports” as mentioned in the conclusion
at the end of the paper.
Please review this paper.
user
Title: Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal
bleeding: Propensity score matching analysis of real-world data from Thailand
Version: 3 Date: 11 Sep 2024
Reviewer's report:
Comments
Chang et al. present a paper regarding the impact of timing of upper gastrointestinal endoscopy
(UGIE) in patients with nonvariceal UGI bleed. It is a propensity score matched analysis of
large number of patients divided into two groups i.e., early (UGIE within 24 hrs of presentation)
vs. late (after 24 hrs). The authors found that after adjusting for potential confounders, early
UGIE was associated with finding high risk stigmata and requirement of hemostatic procedures
and was negatively associated with need for PRBCs transfusion and duration of hospital
stay. However, hard endpoints such as in-hospital mortality, rebleeding, requirement of rescue
surgery or radiological procedures and the admission cost was not different between the two
groups.
Pro - This is a propensity score matched (PSM) study (rightly stating that RCTs would be
unethical considering the varying severity of presentation of this potentially life-threatening
condition). The sample size is also large. Conclusions have been drawned after adjusting for
confounders.
Cons –
Major issue - Smoking is an important cause of ulcer bleed. There is no mention whether it was
equally distributed in the two groups.
Minor issues -
1. Caliper distance for PSM is not mentioned.
2. Page 6 line 188 – In the endoscopic diagnosis and outcome of results section, admission cost
of the late endoscopy group is not in line with what is mentioned in the Table 2.
3. In the conclusion section of the abstract, making a strong statement for early endoscopy as
“recommended” will be too much as I consider the hard endpoints as mentioned by me above
more important. It can be changed to “suggestion” or “supports” as mentioned in the conclusion
at the end of the paper.
assistant