Reviewer ’s report  
Title: Bleeding in patients who underwent scheduled sec ond-look endoscopy 5 days after 
endoscopic submucos al dissection for gastric lesions  
 
Version: 0 Date: 29 Jan 2018  
 
Reviewer: Bhavana Bhagya Rao  
 
Reviewer's report:   
This is a descriptive study of post ESD patient monitoring and attempts to identify factors 
predictive of bleeding. However it does have limitatio ns as follows:  
 
1. None of the included patients were on the newer anticoagulant agents, which are now 
increasingly in use.  
2. In patients with early phase post -ESD bleeding was a diagnostic EGD performed at time of 
bleeding? If so what were the findings of  this endoscopic eval and what sort of hemostasis 
was offered? Thereafter was a SLE also performed on Day 5?  
3. Since antiplatelet and anticoagulant agents were restarted 2 days after procedure was SLE and 
the hemostatic procedures performed while on full anticoagulation on these patients?  
4. In the following statement in the results section "There was no statistically significant 
difference between the group of patients treated with antithrombotic agents and the group of 
patients not receiving treatment (p =0.237)" What is the parameter based on which the two 
groups are being compared here?  
5. In this statement: " Univariate analysis of all 26 lesions with post -ESD bleeding revealed that 
a diameter of the resected specimen ≥40 mm (p=0.036) and antithrombotic  treatment before 
undergoing ESD (p<0.001) were statistically significant factors for bleeding (Table 3)" please 
clarify if this is early or late phase post ESD bleeding.  
6. The study is titled to be a case control study. However no controls have been iden tified.  
7. Further randomized controlled trials are needed to assess if SLE is necessary in post ESD 
patients and if prophylactic hemostasis is beneficial in patients with high risk ulcers. These 
questions are unanswered by current study.  
8. The results do demonstrate that use of anti -thrombotic agents raises risk for post -ESD 
bleeding, but that is quite expected. The continued risk of bleeding despite prophylactic 
hemostasis, might also be related to the fact that antithrombotic therapy wa s ongoing during 
SLE and thereafter.  
9. Please give percentages and total 'n' in Table 2.  
 
Are the methods appropriate and well 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.  
No 
Are the conclusions drawn ade quately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recomme nded, please speci fy what as pects 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 competing 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 sala ry from an  
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publicat ion 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 for 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 bel ow. 
 
'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 an y 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 comm ents 
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 peer review policy of the journal  
Reviewer ’s report  
Title: Bleeding in patients who underwent scheduled sec ond-look endoscopy 5 days after 
endoscopic submucos al dissection for gastric lesions  
 
Version: 0 Date: 29 Jan 2018  
 
Reviewer: Bhavana Bhagya Rao  
 
Reviewer's report:   
This is a descriptive study of post ESD patient monitoring and attempts to identify factors 
predictive of bleeding. However it does have limitatio ns as follows:  
 
1. None of the included patients were on the newer anticoagulant agents, which are now 
increasingly in use.  
2. In patients with early phase post -ESD bleeding was a diagnostic EGD performed at time of 
bleeding? If so what were the findings of  this endoscopic eval and what sort of hemostasis 
was offered? Thereafter was a SLE also performed on Day 5?  
3. Since antiplatelet and anticoagulant agents were restarted 2 days after procedure was SLE and 
the hemostatic procedures performed while on full anticoagulation on these patients?  
4. In the following statement in the results section "There was no statistically significant 
difference between the group of patients treated with antithrombotic agents and the group of 
patients not receiving treatment (p =0.237)" What is the parameter based on which the two 
groups are being compared here?  
5. In this statement: " Univariate analysis of all 26 lesions with post -ESD bleeding revealed that 
a diameter of the resected specimen ≥40 mm (p=0.036) and antithrombotic  treatment before 
undergoing ESD (p<0.001) were statistically significant factors for bleeding (Table 3)" please 
clarify if this is early or late phase post ESD bleeding.  
6. The study is titled to be a case control study. However no controls have been iden tified.  
7. Further randomized controlled trials are needed to assess if SLE is necessary in post ESD 
patients and if prophylactic hemostasis is beneficial in patients with high risk ulcers. These 
questions are unanswered by current study.  
8. The results do demonstrate that use of anti -thrombotic agents raises risk for post -ESD 
bleeding, but that is quite expected. The continued risk of bleeding despite prophylactic 
hemostasis, might also be related to the fact that antithrombotic therapy wa s ongoing during 
SLE and thereafter.  
9. Please give percentages and total 'n' in Table 2.  
 
Are the methods appropriate and well 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.  
No 
Are the conclusions drawn ade quately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recomme nded, please speci fy what as pects 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 competing 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 sala ry from an  
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publicat ion 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 for 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 bel ow. 
 
'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 an y 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 comm ents 
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 peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
Title: Bleeding in patients who underwent scheduled sec ond-look endoscopy 5 days after 
endoscopic submucos al dissection for gastric lesions  
 
Version: 0 Date: 29 Jan 2018  
 
Reviewer: Bhavana Bhagya Rao  
 
Reviewer's report:   
This is a descriptive study of post ESD patient monitoring and attempts to identify factors 
predictive of bleeding. However it does have limitatio ns as follows:  
 
1. None of the included patients were on the newer anticoagulant agents, which are now 
increasingly in use.  
2. In patients with early phase post -ESD bleeding was a diagnostic EGD performed at time of 
bleeding? If so what were the findings of  this endoscopic eval and what sort of hemostasis 
was offered? Thereafter was a SLE also performed on Day 5?  
3. Since antiplatelet and anticoagulant agents were restarted 2 days after procedure was SLE and 
the hemostatic procedures performed while on full anticoagulation on these patients?  
4. In the following statement in the results section "There was no statistically significant 
difference between the group of patients treated with antithrombotic agents and the group of 
patients not receiving treatment (p =0.237)" What is the parameter based on which the two 
groups are being compared here?  
5. In this statement: " Univariate analysis of all 26 lesions with post -ESD bleeding revealed that 
a diameter of the resected specimen ≥40 mm (p=0.036) and antithrombotic  treatment before 
undergoing ESD (p<0.001) were statistically significant factors for bleeding (Table 3)" please 
clarify if this is early or late phase post ESD bleeding.  
6. The study is titled to be a case control study. However no controls have been iden tified.  
7. Further randomized controlled trials are needed to assess if SLE is necessary in post ESD 
patients and if prophylactic hemostasis is beneficial in patients with high risk ulcers. These 
questions are unanswered by current study.  
8. The results do demonstrate that use of anti -thrombotic agents raises risk for post -ESD 
bleeding, but that is quite expected. The continued risk of bleeding despite prophylactic 
hemostasis, might also be related to the fact that antithrombotic therapy wa s ongoing during 
SLE and thereafter.  
9. Please give percentages and total 'n' in Table 2.  
 
Are the methods appropriate and well 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.  
No 
Are the conclusions drawn ade quately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recomme nded, please speci fy what as pects 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 competing 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 sala ry from an  
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publicat ion 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 for 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 bel ow. 
 
'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 an y 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 comm ents 
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 peer review policy of the journal  
assistant