Reviewer ’s report  
 
Title: Clinical outcomes of over -the-scope -clip system for the treatment of acute upper non -
variceal gastrointestinal bleeding: a systematic review and meta -analysis  
 
Version: 0 Date: 26 Oct 2019  
 
Reviewer: Kuang -Chun Hu  
 
Reviewer's report:  
 
This is a systematic review and meta -analysis article to evaluate the effectiveness and safety of 
OTSC system in patients with GI bleeding. The article was well written and addressed the 
important issue about treatment of non -variceal gastrointestinal (GI) bleeding. However, there 
are major epide miologic/analytic/study design problems that need to be addressed.  
 
1.In this field, there several similar articles had talked about this issue. (1 -3) The author's 
conclusion was like other publish papers but their inclusion articles and patients was much  more. 
Authors may consider search again for find more studies.  
2.Since OTSCs is invasive procedure, the adverse events post OTSCs may need further 
considered. Such as perforation or obstruction after OTSCs and some papers had mentions these 
adverse events . 
3.If possible, may consider add subgroup analysis in studies to identified some parameters effect 
in the OTSC treatment in UNVGIB (such as lesion characteristics, study location, study times…. 
)  
 
Reference  
1. WEILAND, Timo, et al. Efficacy of the OTSC S ystem in the treatment of GI bleeding 
and wall defects: a PMCF meta -analysis. Minimally Invasive Therapy &amp;  Allied 
Technologies, 2019, 1 -19. 
2. KOBARA, Hideki, et al. Over ‐the‐scope clip system: A review of 1517 cases over 9 
years. Journal of Gastroente rology and Hepatology, 2019, 34.1: 22 -30. 
3. CHANDRASEKAR, Viveksandeep Thoguluva, et al. Efficacy and safety of over -the-
scope clips for gastrointestinal bleeding: a systematic review and meta -analysis. Endoscopy, 
2019.  
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and w ell described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusion s drawn adequately 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 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 st atistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 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 recei ved 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 below.  
 
I declare that I have no competing interests  
 
I agree to the open peer r eview 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 a s 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: Clinical outcomes of over -the-scope -clip system for the treatment of acute upper non -
variceal gastrointestinal bleeding: a systematic review and meta -analysis  
 
Version: 0 Date: 26 Oct 2019  
 
Reviewer: Kuang -Chun Hu  
 
Reviewer's report:  
 
This is a systematic review and meta -analysis article to evaluate the effectiveness and safety of 
OTSC system in patients with GI bleeding. The article was well written and addressed the 
important issue about treatment of non -variceal gastrointestinal (GI) bleeding. However, there 
are major epide miologic/analytic/study design problems that need to be addressed.  
 
1.In this field, there several similar articles had talked about this issue. (1 -3) The author's 
conclusion was like other publish papers but their inclusion articles and patients was much  more. 
Authors may consider search again for find more studies.  
2.Since OTSCs is invasive procedure, the adverse events post OTSCs may need further 
considered. Such as perforation or obstruction after OTSCs and some papers had mentions these 
adverse events . 
3.If possible, may consider add subgroup analysis in studies to identified some parameters effect 
in the OTSC treatment in UNVGIB (such as lesion characteristics, study location, study times…. 
)  
 
Reference  
1. WEILAND, Timo, et al. Efficacy of the OTSC S ystem in the treatment of GI bleeding 
and wall defects: a PMCF meta -analysis. Minimally Invasive Therapy &amp;  Allied 
Technologies, 2019, 1 -19. 
2. KOBARA, Hideki, et al. Over ‐the‐scope clip system: A review of 1517 cases over 9 
years. Journal of Gastroente rology and Hepatology, 2019, 34.1: 22 -30. 
3. CHANDRASEKAR, Viveksandeep Thoguluva, et al. Efficacy and safety of over -the-
scope clips for gastrointestinal bleeding: a systematic review and meta -analysis. Endoscopy, 
2019.  
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and w ell described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusion s drawn adequately 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 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 st atistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 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 recei ved 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 below.  
 
I declare that I have no competing interests  
 
I agree to the open peer r eview 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 a s 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: Clinical outcomes of over -the-scope -clip system for the treatment of acute upper non -
variceal gastrointestinal bleeding: a systematic review and meta -analysis  
 
Version: 0 Date: 26 Oct 2019  
 
Reviewer: Kuang -Chun Hu  
 
Reviewer's report:  
 
This is a systematic review and meta -analysis article to evaluate the effectiveness and safety of 
OTSC system in patients with GI bleeding. The article was well written and addressed the 
important issue about treatment of non -variceal gastrointestinal (GI) bleeding. However, there 
are major epide miologic/analytic/study design problems that need to be addressed.  
 
1.In this field, there several similar articles had talked about this issue. (1 -3) The author's 
conclusion was like other publish papers but their inclusion articles and patients was much  more. 
Authors may consider search again for find more studies.  
2.Since OTSCs is invasive procedure, the adverse events post OTSCs may need further 
considered. Such as perforation or obstruction after OTSCs and some papers had mentions these 
adverse events . 
3.If possible, may consider add subgroup analysis in studies to identified some parameters effect 
in the OTSC treatment in UNVGIB (such as lesion characteristics, study location, study times…. 
)  
 
Reference  
1. WEILAND, Timo, et al. Efficacy of the OTSC S ystem in the treatment of GI bleeding 
and wall defects: a PMCF meta -analysis. Minimally Invasive Therapy &amp;  Allied 
Technologies, 2019, 1 -19. 
2. KOBARA, Hideki, et al. Over ‐the‐scope clip system: A review of 1517 cases over 9 
years. Journal of Gastroente rology and Hepatology, 2019, 34.1: 22 -30. 
3. CHANDRASEKAR, Viveksandeep Thoguluva, et al. Efficacy and safety of over -the-
scope clips for gastrointestinal bleeding: a systematic review and meta -analysis. Endoscopy, 
2019.  
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and w ell described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusion s drawn adequately 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 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 st atistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 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 recei ved 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 below.  
 
I declare that I have no competing interests  
 
I agree to the open peer r eview 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 a s confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant