Title: Transjugular liver biopsy: enlarge the indications for liver biopsy with reliable diagnostic
quality
Version: 0 Date: 29 Jun 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This manuscript compares TJLB to PLB, with particular attention
to efficacy to make a diagnosis. The authors structured the research question well and provided
propensity matching to address confounders. The only drawback is that after propensity
matching, there are only 26 patients in each gap making the sample size small, and hence less
robust. Further, the reader is left with the impression that these procedures are interchangeable
and hence can be compared. However, that's a false equivalency. And finally, all adverse events
should be reported using standard reporting guidelines such as CTCAE
REQUESTED REVISIONS:
Abstract - Complications should be listed using standard CTCAE criteria and graded. Not all
complications are clinically significant and readers should be able to judge relevance
The number of TJLB patients are very few for a 10 year experience - needles have changed and
criteria have changed over 10 years
With increasing incidence of NASH, the number of portal tracts obtained is critical. PLB is
clearly a winner in that regard, and this strength should be highlighted.
Please remove the word unknown from line 17 - "the diagnostic efficiency of unknown liver
dz..." it makes the statement confusing
The conclusion statement is a bit over the top and needs to be toned down
Introduction - line 6. TJLB is not a superior method, but a SAFER method in patients with coag
abnl
Method -definition of bleeding. Please clarify that only changes in BP were considered
significant. There are a lot of people with 90/60 BP who live at that BP normally.
Results - while patients were matched to ascites in the PSM grp, the numbers are very small to
ensure that these gaps are adequately matched on key factors that mandate a TJLB
Major critique that needs to be addressed - all complications have to be stated using CTCAE
since that grading is standardized. Current complication rate seems to be anecdotal and
subjective. Please change
The authors state that when it came to staging of cirrhosis, they clinically performed a PLB
since the number of tracts is critical to the staging. While they do mention it, its in passing and
should be elaborated
In summary - the major limitations of this manuscript are 1) Adverse events have to be
categorized using standard algorithms. CTCAE helps standardize these events and is used
routinely by all journals 2)The authors fail to define and elaborate on the actual clinical indication
for TJLB and PLB. TJLB is used in patients with ascites or coag disorders. PLB is better at
staging and fibrosis evaluation. Both have their roles and making them sound interchangeable
makes its false equivalency. This should be discussed in detail in discussion as well as the
limitations
Title: Transjugular liver biopsy: enlarge the indications for liver biopsy with reliable diagnostic
quality
Version: 0 Date: 29 Jun 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This manuscript compares TJLB to PLB, with particular attention
to efficacy to make a diagnosis. The authors structured the research question well and provided
propensity matching to address confounders. The only drawback is that after propensity
matching, there are only 26 patients in each gap making the sample size small, and hence less
robust. Further, the reader is left with the impression that these procedures are interchangeable
and hence can be compared. However, that's a false equivalency. And finally, all adverse events
should be reported using standard reporting guidelines such as CTCAE
REQUESTED REVISIONS:
Abstract - Complications should be listed using standard CTCAE criteria and graded. Not all
complications are clinically significant and readers should be able to judge relevance
The number of TJLB patients are very few for a 10 year experience - needles have changed and
criteria have changed over 10 years
With increasing incidence of NASH, the number of portal tracts obtained is critical. PLB is
clearly a winner in that regard, and this strength should be highlighted.
Please remove the word unknown from line 17 - "the diagnostic efficiency of unknown liver
dz..." it makes the statement confusing
The conclusion statement is a bit over the top and needs to be toned down
Introduction - line 6. TJLB is not a superior method, but a SAFER method in patients with coag
abnl
Method -definition of bleeding. Please clarify that only changes in BP were considered
significant. There are a lot of people with 90/60 BP who live at that BP normally.
Results - while patients were matched to ascites in the PSM grp, the numbers are very small to
ensure that these gaps are adequately matched on key factors that mandate a TJLB
Major critique that needs to be addressed - all complications have to be stated using CTCAE
since that grading is standardized. Current complication rate seems to be anecdotal and
subjective. Please change
The authors state that when it came to staging of cirrhosis, they clinically performed a PLB
since the number of tracts is critical to the staging. While they do mention it, its in passing and
should be elaborated
In summary - the major limitations of this manuscript are 1) Adverse events have to be
categorized using standard algorithms. CTCAE helps standardize these events and is used
routinely by all journals 2)The authors fail to define and elaborate on the actual clinical indication
for TJLB and PLB. TJLB is used in patients with ascites or coag disorders. PLB is better at
staging and fibrosis evaluation. Both have their roles and making them sound interchangeable
makes its false equivalency. This should be discussed in detail in discussion as well as the
limitations
Please review this paper.
user
Title: Transjugular liver biopsy: enlarge the indications for liver biopsy with reliable diagnostic
quality
Version: 0 Date: 29 Jun 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This manuscript compares TJLB to PLB, with particular attention
to efficacy to make a diagnosis. The authors structured the research question well and provided
propensity matching to address confounders. The only drawback is that after propensity
matching, there are only 26 patients in each gap making the sample size small, and hence less
robust. Further, the reader is left with the impression that these procedures are interchangeable
and hence can be compared. However, that's a false equivalency. And finally, all adverse events
should be reported using standard reporting guidelines such as CTCAE
REQUESTED REVISIONS:
Abstract - Complications should be listed using standard CTCAE criteria and graded. Not all
complications are clinically significant and readers should be able to judge relevance
The number of TJLB patients are very few for a 10 year experience - needles have changed and
criteria have changed over 10 years
With increasing incidence of NASH, the number of portal tracts obtained is critical. PLB is
clearly a winner in that regard, and this strength should be highlighted.
Please remove the word unknown from line 17 - "the diagnostic efficiency of unknown liver
dz..." it makes the statement confusing
The conclusion statement is a bit over the top and needs to be toned down
Introduction - line 6. TJLB is not a superior method, but a SAFER method in patients with coag
abnl
Method -definition of bleeding. Please clarify that only changes in BP were considered
significant. There are a lot of people with 90/60 BP who live at that BP normally.
Results - while patients were matched to ascites in the PSM grp, the numbers are very small to
ensure that these gaps are adequately matched on key factors that mandate a TJLB
Major critique that needs to be addressed - all complications have to be stated using CTCAE
since that grading is standardized. Current complication rate seems to be anecdotal and
subjective. Please change
The authors state that when it came to staging of cirrhosis, they clinically performed a PLB
since the number of tracts is critical to the staging. While they do mention it, its in passing and
should be elaborated
In summary - the major limitations of this manuscript are 1) Adverse events have to be
categorized using standard algorithms. CTCAE helps standardize these events and is used
routinely by all journals 2)The authors fail to define and elaborate on the actual clinical indication
for TJLB and PLB. TJLB is used in patients with ascites or coag disorders. PLB is better at
staging and fibrosis evaluation. Both have their roles and making them sound interchangeable
makes its false equivalency. This should be discussed in detail in discussion as well as the
limitations
assistant