Title: Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal
bleeding: Propensity score matching analysis of real-world data from Thailand
Version: 3 Date: 10 Sep 2024
Reviewer's report:
I have read with great interest the work done by authors for an very pertinent topic However i
have a few comments regarding the study-
Methodology/Definitions-
1.The authors define endoscopy within 24 hours vs after 24 hours. Multiple studies including
Lau et al (NEJM 2020) have not any benefit over urgent (6-24 HOURS) as compared to 24 hours.
Also is the time to endoscopy 24 hours or above or is it the duration of malena/hemetemesis
with which the patients presents with ?Needs more clarity
However delaying endoscopy further does not seem to have any rationale.This seems to be a
major drawback of the study
2.Further the authors in the exclusion criteria mention -unstable medical condition or designated
palliative that precluded definitive intervention.
However in the methods section it is written-"Regarding our center’s protocol, after
hemodynamic stabilization"
The authors need to explain this statement what criteria was used for hemodynamic stability
3.What was time taken for Hemodynamic resuscitation ?Did inadequate resuscitation in the late
group lead to lower rates of hemostatsis?
4.The authors need to carry out analysis including time dependent bleeding rates
5.By delaying endoscopy(>24 hours) it is obvious the patients will require more transfusion so
the comparison may be flawed
Title: Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal
bleeding: Propensity score matching analysis of real-world data from Thailand
Version: 3 Date: 10 Sep 2024
Reviewer's report:
I have read with great interest the work done by authors for an very pertinent topic However i
have a few comments regarding the study-
Methodology/Definitions-
1.The authors define endoscopy within 24 hours vs after 24 hours. Multiple studies including
Lau et al (NEJM 2020) have not any benefit over urgent (6-24 HOURS) as compared to 24 hours.
Also is the time to endoscopy 24 hours or above or is it the duration of malena/hemetemesis
with which the patients presents with ?Needs more clarity
However delaying endoscopy further does not seem to have any rationale.This seems to be a
major drawback of the study
2.Further the authors in the exclusion criteria mention -unstable medical condition or designated
palliative that precluded definitive intervention.
However in the methods section it is written-"Regarding our center’s protocol, after
hemodynamic stabilization"
The authors need to explain this statement what criteria was used for hemodynamic stability
3.What was time taken for Hemodynamic resuscitation ?Did inadequate resuscitation in the late
group lead to lower rates of hemostatsis?
4.The authors need to carry out analysis including time dependent bleeding rates
5.By delaying endoscopy(>24 hours) it is obvious the patients will require more transfusion so
the comparison may be flawed
Please review this paper.
user
Title: Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal
bleeding: Propensity score matching analysis of real-world data from Thailand
Version: 3 Date: 10 Sep 2024
Reviewer's report:
I have read with great interest the work done by authors for an very pertinent topic However i
have a few comments regarding the study-
Methodology/Definitions-
1.The authors define endoscopy within 24 hours vs after 24 hours. Multiple studies including
Lau et al (NEJM 2020) have not any benefit over urgent (6-24 HOURS) as compared to 24 hours.
Also is the time to endoscopy 24 hours or above or is it the duration of malena/hemetemesis
with which the patients presents with ?Needs more clarity
However delaying endoscopy further does not seem to have any rationale.This seems to be a
major drawback of the study
2.Further the authors in the exclusion criteria mention -unstable medical condition or designated
palliative that precluded definitive intervention.
However in the methods section it is written-"Regarding our center’s protocol, after
hemodynamic stabilization"
The authors need to explain this statement what criteria was used for hemodynamic stability
3.What was time taken for Hemodynamic resuscitation ?Did inadequate resuscitation in the late
group lead to lower rates of hemostatsis?
4.The authors need to carry out analysis including time dependent bleeding rates
5.By delaying endoscopy(>24 hours) it is obvious the patients will require more transfusion so
the comparison may be flawed
assistant