Title: Endoscopic resection for esophageal granular cell tumors: report of 62 cases
Version: 3 Date: 24 Sep 2024
Reviewer:  Ippei Tanaka
Reviewer's report:
In this study, the clinical manifestations, endoscopic features, pathological features, endoscopic
resection, and prognosis of esophageal granular cell tumors (GCTs) are clarified. It is a well-
organized and insightful paper, but I believe some improvements are necessary.
Major Comments
1. I feel that R1 resections are relatively frequent. What do you think is the reason for this? If
possible, please analyze the risk factors that lead to R1 resection. Does a larger tumor increase
the likelihood of R1 resection, or is it related to the choice of endoscopic treatment technique?
2. Regarding the selection of different treatment methods, the following is mentioned in the
Methods section:
“The treatment strategies depended on the size and the depth of infiltration of the esophageal wall
and also on local expertise. Three superficial lesions originating from the mucosal muscle layer
were resected by snare excision, 52 lesions originating from the mucosal muscle or submucosal
layer were resected by ESD, and seven lesions originating from the muscularis propria layer
were resected by STER.”
Are these findings based on postoperative pathological diagnoses? If so, how were these
diagnoses made preoperatively? Was it through EUS or endoscopic findings? On the other
hand, if these are preoperative findings, how did you diagnose the origin of the tumor? And, in
the end, were the preoperative diagnoses of the tumor origin consistent with the postoperative
pathological diagnoses?
3. Related to the above question, how does the author believe the different treatments (EMR,
ESD, STER) should be selected? Please describe the criteria based on the specific preoperative
findings.
Minor Comments
1. What was the follow-up duration? Please provide the average follow-up period.
2. It is mentioned that there were no complications during and after the endoscopic treatments.
Given that cases with MP invasion required muscle layer dissection, did no perforation occur?
3. On page 3, line 18, "the 1rd" is written. Is this a mistake for "the 1st"?
4. In your study, there were 11 symptomatic cases. Did the patients who reported especially
choking or difficulty swallowing show improvement after treatment?
Title: Endoscopic resection for esophageal granular cell tumors: report of 62 cases
Version: 3 Date: 24 Sep 2024
Reviewer:  Ippei Tanaka
Reviewer's report:
In this study, the clinical manifestations, endoscopic features, pathological features, endoscopic
resection, and prognosis of esophageal granular cell tumors (GCTs) are clarified. It is a well-
organized and insightful paper, but I believe some improvements are necessary.
Major Comments
1. I feel that R1 resections are relatively frequent. What do you think is the reason for this? If
possible, please analyze the risk factors that lead to R1 resection. Does a larger tumor increase
the likelihood of R1 resection, or is it related to the choice of endoscopic treatment technique?
2. Regarding the selection of different treatment methods, the following is mentioned in the
Methods section:
“The treatment strategies depended on the size and the depth of infiltration of the esophageal wall
and also on local expertise. Three superficial lesions originating from the mucosal muscle layer
were resected by snare excision, 52 lesions originating from the mucosal muscle or submucosal
layer were resected by ESD, and seven lesions originating from the muscularis propria layer
were resected by STER.”
Are these findings based on postoperative pathological diagnoses? If so, how were these
diagnoses made preoperatively? Was it through EUS or endoscopic findings? On the other
hand, if these are preoperative findings, how did you diagnose the origin of the tumor? And, in
the end, were the preoperative diagnoses of the tumor origin consistent with the postoperative
pathological diagnoses?
3. Related to the above question, how does the author believe the different treatments (EMR,
ESD, STER) should be selected? Please describe the criteria based on the specific preoperative
findings.
Minor Comments
1. What was the follow-up duration? Please provide the average follow-up period.
2. It is mentioned that there were no complications during and after the endoscopic treatments.
Given that cases with MP invasion required muscle layer dissection, did no perforation occur?
3. On page 3, line 18, "the 1rd" is written. Is this a mistake for "the 1st"?
4. In your study, there were 11 symptomatic cases. Did the patients who reported especially
choking or difficulty swallowing show improvement after treatment?
Please review this paper.
user
Title: Endoscopic resection for esophageal granular cell tumors: report of 62 cases
Version: 3 Date: 24 Sep 2024
Reviewer:  Ippei Tanaka
Reviewer's report:
In this study, the clinical manifestations, endoscopic features, pathological features, endoscopic
resection, and prognosis of esophageal granular cell tumors (GCTs) are clarified. It is a well-
organized and insightful paper, but I believe some improvements are necessary.
Major Comments
1. I feel that R1 resections are relatively frequent. What do you think is the reason for this? If
possible, please analyze the risk factors that lead to R1 resection. Does a larger tumor increase
the likelihood of R1 resection, or is it related to the choice of endoscopic treatment technique?
2. Regarding the selection of different treatment methods, the following is mentioned in the
Methods section:
“The treatment strategies depended on the size and the depth of infiltration of the esophageal wall
and also on local expertise. Three superficial lesions originating from the mucosal muscle layer
were resected by snare excision, 52 lesions originating from the mucosal muscle or submucosal
layer were resected by ESD, and seven lesions originating from the muscularis propria layer
were resected by STER.”
Are these findings based on postoperative pathological diagnoses? If so, how were these
diagnoses made preoperatively? Was it through EUS or endoscopic findings? On the other
hand, if these are preoperative findings, how did you diagnose the origin of the tumor? And, in
the end, were the preoperative diagnoses of the tumor origin consistent with the postoperative
pathological diagnoses?
3. Related to the above question, how does the author believe the different treatments (EMR,
ESD, STER) should be selected? Please describe the criteria based on the specific preoperative
findings.
Minor Comments
1. What was the follow-up duration? Please provide the average follow-up period.
2. It is mentioned that there were no complications during and after the endoscopic treatments.
Given that cases with MP invasion required muscle layer dissection, did no perforation occur?
3. On page 3, line 18, "the 1rd" is written. Is this a mistake for "the 1st"?
4. In your study, there were 11 symptomatic cases. Did the patients who reported especially
choking or difficulty swallowing show improvement after treatment?
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