Reviewer ’s report  
 
Title: Clinical Outcomes of Endoscopic Mucosal Resection f or Rectal Neuroendocrine Tumor  
 
Version: 0 Date: 10 Nov 2017  
 
Reviewer: Masau Sekiguchi  
 
Reviewer's report:  
 
The manuscript described the clinical outcomes of EMR for rectal NET. It included important 
data; however, several issues should be discussed more and revised.  
1. In this study, the H -CR rate of EMR, mostly composed of conven tional EMR, was not 
satisfactorily. However, this result is easily predictable because many previous studies 
already have reported that conventional EMR is not suitable for achieving complete resection 
of rectal NETs. Although this study also included pati ents undergoing EMR -D and EMR -P, 
the number of those patients were small and it would be difficult to deny the usefulness of 
those advanced EMR methods only from this study. Regarding advanced EMR methods, 
several previous studies have shown that ESMR -L an d EMR -C (endoscopic mucosal 
resection using a cap -fitted panendas - cope) are superior to conventional EMR in achieving 
R0 resection of rectal NETs; thus, before concluding that conventional EMR appears to be 
efficient for the treatment of rectal NETs, ESMR -L and EMR -C, which require short 
procedure -time, also should be investigated.  
 
2. One of the aims of this study was to evaluate the recurrence rate after EMR for rectal NETs. 
However, the follow -up period was short.  
 
3. It would be better to describe clearly the indications of EMR and how to select the EMR 
method (EMR, EMR -D, EMR -P). At least, principal indications for endoscopic treatment 
and surgery should be clarified in the manuscript.  
 
4. It is necessary to descri be why the authors excluded the patients who did not receive 
endoscopically complete resection form this study.  
Are the methods appropriate and wel l described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is  recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competi ng interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this  manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied f or patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses.  I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do  not wish to be included in my named report can be included as confidential comments 
to the  editors, which will not be published.  
 
I agree to the open pee r review policy of the journal  
Reviewer ’s report  
 
Title: Clinical Outcomes of Endoscopic Mucosal Resection f or Rectal Neuroendocrine Tumor  
 
Version: 0 Date: 10 Nov 2017  
 
Reviewer: Masau Sekiguchi  
 
Reviewer's report:  
 
The manuscript described the clinical outcomes of EMR for rectal NET. It included important 
data; however, several issues should be discussed more and revised.  
1. In this study, the H -CR rate of EMR, mostly composed of conven tional EMR, was not 
satisfactorily. However, this result is easily predictable because many previous studies 
already have reported that conventional EMR is not suitable for achieving complete resection 
of rectal NETs. Although this study also included pati ents undergoing EMR -D and EMR -P, 
the number of those patients were small and it would be difficult to deny the usefulness of 
those advanced EMR methods only from this study. Regarding advanced EMR methods, 
several previous studies have shown that ESMR -L an d EMR -C (endoscopic mucosal 
resection using a cap -fitted panendas - cope) are superior to conventional EMR in achieving 
R0 resection of rectal NETs; thus, before concluding that conventional EMR appears to be 
efficient for the treatment of rectal NETs, ESMR -L and EMR -C, which require short 
procedure -time, also should be investigated.  
 
2. One of the aims of this study was to evaluate the recurrence rate after EMR for rectal NETs. 
However, the follow -up period was short.  
 
3. It would be better to describe clearly the indications of EMR and how to select the EMR 
method (EMR, EMR -D, EMR -P). At least, principal indications for endoscopic treatment 
and surgery should be clarified in the manuscript.  
 
4. It is necessary to descri be why the authors excluded the patients who did not receive 
endoscopically complete resection form this study.  
Are the methods appropriate and wel l described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is  recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competi ng interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this  manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied f or patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses.  I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do  not wish to be included in my named report can be included as confidential comments 
to the  editors, which will not be published.  
 
I agree to the open pee r review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Clinical Outcomes of Endoscopic Mucosal Resection f or Rectal Neuroendocrine Tumor  
 
Version: 0 Date: 10 Nov 2017  
 
Reviewer: Masau Sekiguchi  
 
Reviewer's report:  
 
The manuscript described the clinical outcomes of EMR for rectal NET. It included important 
data; however, several issues should be discussed more and revised.  
1. In this study, the H -CR rate of EMR, mostly composed of conven tional EMR, was not 
satisfactorily. However, this result is easily predictable because many previous studies 
already have reported that conventional EMR is not suitable for achieving complete resection 
of rectal NETs. Although this study also included pati ents undergoing EMR -D and EMR -P, 
the number of those patients were small and it would be difficult to deny the usefulness of 
those advanced EMR methods only from this study. Regarding advanced EMR methods, 
several previous studies have shown that ESMR -L an d EMR -C (endoscopic mucosal 
resection using a cap -fitted panendas - cope) are superior to conventional EMR in achieving 
R0 resection of rectal NETs; thus, before concluding that conventional EMR appears to be 
efficient for the treatment of rectal NETs, ESMR -L and EMR -C, which require short 
procedure -time, also should be investigated.  
 
2. One of the aims of this study was to evaluate the recurrence rate after EMR for rectal NETs. 
However, the follow -up period was short.  
 
3. It would be better to describe clearly the indications of EMR and how to select the EMR 
method (EMR, EMR -D, EMR -P). At least, principal indications for endoscopic treatment 
and surgery should be clarified in the manuscript.  
 
4. It is necessary to descri be why the authors excluded the patients who did not receive 
endoscopically complete resection form this study.  
Are the methods appropriate and wel l described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is  recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competi ng interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this  manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied f or patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses.  I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do  not wish to be included in my named report can be included as confidential comments 
to the  editors, which will not be published.  
 
I agree to the open pee r review policy of the journal  
assistant