Title: Comparison of efficiency and safety between dual-clip and rubber band-assisted ESD and
conventional ESD for colonic lateral spreading tumors (LSTs) with different levels of technical
difficulty: A retrospective case-control study
Version: 1 Date: 02 Aug 2022
Reviewer:  Hideharu Ogiyama
Reviewer's report:
The authors conducted a single center retrospective study in which the aim was to evaluate the
effectiveness of dual-clip and rubber band-assisted submucosal dissection. This is an important
question to answer. I would like to raise some points to improve this manuscript.
Major comments
1.
Why did you exclude the patients with rectal cases?
I think there are rectal cases in which traction in ESD is effective.
Please describe this point.
2.
You excluded unplanned DCRB-ESD cases.
These cases are the cases that should be treated with DCRB and it would be helpful to clarify
the characteristics of these cases. So, you should add more description.
3.
Is there another factor that the cases with CRESD score0 need more time other than the factor
that endoscopist tends to not apply DCRB in easy cases?
I think there is a possibility that in easier lesions it takes additional time to use the dual-clip and
rubber band and it takes more time.
You should discuss whether it is better not to use DCRB with easy lesions (CRESD score0).
4.
The analysis in table2 is based on the clinical score model for grading the technical difficulty
of colorectal ESD and if the scoring system has already published you should cite the paper. If
not, the summary of the results based on this score should be described.
5.
Is there any situation that it becomes difficult to perform ESD if you use DCRB?
Minor comments
1.
p.14, lines 11 -14
“In subgroups with a score of 4-5, the between-group operation duration was not significantly
different due to limited cases, although these values differed greatly (100.5 vs. 55.5 and p =
0.33, 142 vs. 176 and p =1.0, respectively)”
You should clarify which time is DCRB-ESD or C-ESD. It is confusing.
2.
4 cases need several DCRB sets. You should describe the characteristics of these cases.
3.
p.3, lines 21 -22
I think the median ESD operation time of DCRB-ESD and C-ESD is reversed. Please correct.
4.
What is CS -CRESD 0? According to the prediction model you described, the minimum score is
1. I think “1 point when size < 50 mm, 2 points when size # 50mm.”  is a mistake. Please correct.
Title: Comparison of efficiency and safety between dual-clip and rubber band-assisted ESD and
conventional ESD for colonic lateral spreading tumors (LSTs) with different levels of technical
difficulty: A retrospective case-control study
Version: 1 Date: 02 Aug 2022
Reviewer:  Hideharu Ogiyama
Reviewer's report:
The authors conducted a single center retrospective study in which the aim was to evaluate the
effectiveness of dual-clip and rubber band-assisted submucosal dissection. This is an important
question to answer. I would like to raise some points to improve this manuscript.
Major comments
1.
Why did you exclude the patients with rectal cases?
I think there are rectal cases in which traction in ESD is effective.
Please describe this point.
2.
You excluded unplanned DCRB-ESD cases.
These cases are the cases that should be treated with DCRB and it would be helpful to clarify
the characteristics of these cases. So, you should add more description.
3.
Is there another factor that the cases with CRESD score0 need more time other than the factor
that endoscopist tends to not apply DCRB in easy cases?
I think there is a possibility that in easier lesions it takes additional time to use the dual-clip and
rubber band and it takes more time.
You should discuss whether it is better not to use DCRB with easy lesions (CRESD score0).
4.
The analysis in table2 is based on the clinical score model for grading the technical difficulty
of colorectal ESD and if the scoring system has already published you should cite the paper. If
not, the summary of the results based on this score should be described.
5.
Is there any situation that it becomes difficult to perform ESD if you use DCRB?
Minor comments
1.
p.14, lines 11 -14
“In subgroups with a score of 4-5, the between-group operation duration was not significantly
different due to limited cases, although these values differed greatly (100.5 vs. 55.5 and p =
0.33, 142 vs. 176 and p =1.0, respectively)”
You should clarify which time is DCRB-ESD or C-ESD. It is confusing.
2.
4 cases need several DCRB sets. You should describe the characteristics of these cases.
3.
p.3, lines 21 -22
I think the median ESD operation time of DCRB-ESD and C-ESD is reversed. Please correct.
4.
What is CS -CRESD 0? According to the prediction model you described, the minimum score is
1. I think “1 point when size < 50 mm, 2 points when size # 50mm.”  is a mistake. Please correct.
Please review this paper.
user
Title: Comparison of efficiency and safety between dual-clip and rubber band-assisted ESD and
conventional ESD for colonic lateral spreading tumors (LSTs) with different levels of technical
difficulty: A retrospective case-control study
Version: 1 Date: 02 Aug 2022
Reviewer:  Hideharu Ogiyama
Reviewer's report:
The authors conducted a single center retrospective study in which the aim was to evaluate the
effectiveness of dual-clip and rubber band-assisted submucosal dissection. This is an important
question to answer. I would like to raise some points to improve this manuscript.
Major comments
1.
Why did you exclude the patients with rectal cases?
I think there are rectal cases in which traction in ESD is effective.
Please describe this point.
2.
You excluded unplanned DCRB-ESD cases.
These cases are the cases that should be treated with DCRB and it would be helpful to clarify
the characteristics of these cases. So, you should add more description.
3.
Is there another factor that the cases with CRESD score0 need more time other than the factor
that endoscopist tends to not apply DCRB in easy cases?
I think there is a possibility that in easier lesions it takes additional time to use the dual-clip and
rubber band and it takes more time.
You should discuss whether it is better not to use DCRB with easy lesions (CRESD score0).
4.
The analysis in table2 is based on the clinical score model for grading the technical difficulty
of colorectal ESD and if the scoring system has already published you should cite the paper. If
not, the summary of the results based on this score should be described.
5.
Is there any situation that it becomes difficult to perform ESD if you use DCRB?
Minor comments
1.
p.14, lines 11 -14
“In subgroups with a score of 4-5, the between-group operation duration was not significantly
different due to limited cases, although these values differed greatly (100.5 vs. 55.5 and p =
0.33, 142 vs. 176 and p =1.0, respectively)”
You should clarify which time is DCRB-ESD or C-ESD. It is confusing.
2.
4 cases need several DCRB sets. You should describe the characteristics of these cases.
3.
p.3, lines 21 -22
I think the median ESD operation time of DCRB-ESD and C-ESD is reversed. Please correct.
4.
What is CS -CRESD 0? According to the prediction model you described, the minimum score is
1. I think “1 point when size < 50 mm, 2 points when size # 50mm.”  is a mistake. Please correct.
assistant