Title: Usefulness of the combined orthodontic rubber band and clip method for gastric
endoscopic submucosal dissection
Version: 1 Date: 02 Nov 2022
Reviewer's report:
The authors described the usefulness of orthodontic rubber band (ORB)-assisted ESD compared
with the conventional method based on the detailed clinical data. Most of the data in this
manuscript are convincing and presented by well-designed analysis. This manuscript provides
an important contribution to the rapidly growing field of ESD. However, I have some questions
about this study to strengthen the manuscript.
Major issues
#1 The ORB may slip off when the stomach was over-insufflated due to the lack of elasticity
or extensibility compared with other internal traction methods (e.g., S-O clip, multiloop). As
the authors mentioned, slip-off seems to have occurred in cases where the stomach was over-
insufflated by the trainee. Was the ORB attached after the stomach had been significantly
degassed?
#2 If the retroflexed endoscopic position was selected for submucosal dissection, there is a
possibility of contact between the endoscope and ORB, which may result in a slip-off of the
ORB. How did authors avoid this problem? Did the authors perform all cases with the forward
endoscopic position?
#3 As the authors described, the ORB was attached to the contralateral normal mucosa, which
may provide traction vertical to the gastric wall in most cases. What traction direction against
the gastric wall or endoscope tip did this procedure provide actually?
#4 Authors stated that "We set the caliper value to 0.2 for a 1:1 match to select patients."
Please clarify the specific method of PSM (e.g., Nearest Neighbor Matching) and the presence
or absence of replacement.
#5 Please provide statistical evidence regarding the validity and multicollinearity of the PSM
analysis (e.g., Hosmer-Lemeshow test, C statistic, standard difference score, variance inflation
factors of explanatory variables).
Minor issues
#1 Please add not only specimen size but also tumor size to the table before and after matching.
#2 For lesions that develop in anatomically narrow areas, such as those near the esophagogastric
junction or pyloric ring, it may be sometimes difficult to achieve the appropriate distance
between the anchor point of the gastric wall and the lesion to gain sufficient traction force. How
did the authors address this problem?
Title: Usefulness of the combined orthodontic rubber band and clip method for gastric
endoscopic submucosal dissection
Version: 1 Date: 02 Nov 2022
Reviewer's report:
The authors described the usefulness of orthodontic rubber band (ORB)-assisted ESD compared
with the conventional method based on the detailed clinical data. Most of the data in this
manuscript are convincing and presented by well-designed analysis. This manuscript provides
an important contribution to the rapidly growing field of ESD. However, I have some questions
about this study to strengthen the manuscript.
Major issues
#1 The ORB may slip off when the stomach was over-insufflated due to the lack of elasticity
or extensibility compared with other internal traction methods (e.g., S-O clip, multiloop). As
the authors mentioned, slip-off seems to have occurred in cases where the stomach was over-
insufflated by the trainee. Was the ORB attached after the stomach had been significantly
degassed?
#2 If the retroflexed endoscopic position was selected for submucosal dissection, there is a
possibility of contact between the endoscope and ORB, which may result in a slip-off of the
ORB. How did authors avoid this problem? Did the authors perform all cases with the forward
endoscopic position?
#3 As the authors described, the ORB was attached to the contralateral normal mucosa, which
may provide traction vertical to the gastric wall in most cases. What traction direction against
the gastric wall or endoscope tip did this procedure provide actually?
#4 Authors stated that "We set the caliper value to 0.2 for a 1:1 match to select patients."
Please clarify the specific method of PSM (e.g., Nearest Neighbor Matching) and the presence
or absence of replacement.
#5 Please provide statistical evidence regarding the validity and multicollinearity of the PSM
analysis (e.g., Hosmer-Lemeshow test, C statistic, standard difference score, variance inflation
factors of explanatory variables).
Minor issues
#1 Please add not only specimen size but also tumor size to the table before and after matching.
#2 For lesions that develop in anatomically narrow areas, such as those near the esophagogastric
junction or pyloric ring, it may be sometimes difficult to achieve the appropriate distance
between the anchor point of the gastric wall and the lesion to gain sufficient traction force. How
did the authors address this problem?
Please review this paper.
user
Title: Usefulness of the combined orthodontic rubber band and clip method for gastric
endoscopic submucosal dissection
Version: 1 Date: 02 Nov 2022
Reviewer's report:
The authors described the usefulness of orthodontic rubber band (ORB)-assisted ESD compared
with the conventional method based on the detailed clinical data. Most of the data in this
manuscript are convincing and presented by well-designed analysis. This manuscript provides
an important contribution to the rapidly growing field of ESD. However, I have some questions
about this study to strengthen the manuscript.
Major issues
#1 The ORB may slip off when the stomach was over-insufflated due to the lack of elasticity
or extensibility compared with other internal traction methods (e.g., S-O clip, multiloop). As
the authors mentioned, slip-off seems to have occurred in cases where the stomach was over-
insufflated by the trainee. Was the ORB attached after the stomach had been significantly
degassed?
#2 If the retroflexed endoscopic position was selected for submucosal dissection, there is a
possibility of contact between the endoscope and ORB, which may result in a slip-off of the
ORB. How did authors avoid this problem? Did the authors perform all cases with the forward
endoscopic position?
#3 As the authors described, the ORB was attached to the contralateral normal mucosa, which
may provide traction vertical to the gastric wall in most cases. What traction direction against
the gastric wall or endoscope tip did this procedure provide actually?
#4 Authors stated that "We set the caliper value to 0.2 for a 1:1 match to select patients."
Please clarify the specific method of PSM (e.g., Nearest Neighbor Matching) and the presence
or absence of replacement.
#5 Please provide statistical evidence regarding the validity and multicollinearity of the PSM
analysis (e.g., Hosmer-Lemeshow test, C statistic, standard difference score, variance inflation
factors of explanatory variables).
Minor issues
#1 Please add not only specimen size but also tumor size to the table before and after matching.
#2 For lesions that develop in anatomically narrow areas, such as those near the esophagogastric
junction or pyloric ring, it may be sometimes difficult to achieve the appropriate distance
between the anchor point of the gastric wall and the lesion to gain sufficient traction force. How
did the authors address this problem?
assistant