Title: Three-dimensional visualization improves the endoscopic diagnosis of superficial gastric
neoplasia
Version: 1 Date: 09 Feb 2021
Reviewer's report:
In this article, Higuchi et al. explorated the usefulness of 3D images in delineation and
determining the morphology for early gastric cancers.  I think this topic is very interesting and
clinically important because early gastric cancer is difficult to be detected in routine endoscopy
exam. It might provide another opportunity toward better diagnosis with this technology.
However, I have several questions:
1.In the WLI group, do you have indigocarmine spray? In the conventional 2D observation, it
is difficult to delineate, and determine the morphology without chromoendoscopy. I think it is
more meaningful to compare the efficacy in the presence of chromoendoscopy.
2.Have you compared the group A and group B (differed by the chronology of 2D/3D images)
for the difference? Since it a cross-over study, it may be important to see if different study
protocol would have influenced the outcomes.
3.How do you determine the "correct" morphology of the lesions in this study? The morphologic
classification systems such as Paris classification are notorious for discrepancy in determine the
flat/depressed lesions even among experts. This is also true in this study that the flat/depressed
lesions have suboptimal accuracy with the aids of 3D image and NBI. I do believe 3D image
can be more accurate in morphology, but the question need to be answered for the validity of
this analysis.
Title: Three-dimensional visualization improves the endoscopic diagnosis of superficial gastric
neoplasia
Version: 1 Date: 09 Feb 2021
Reviewer's report:
In this article, Higuchi et al. explorated the usefulness of 3D images in delineation and
determining the morphology for early gastric cancers.  I think this topic is very interesting and
clinically important because early gastric cancer is difficult to be detected in routine endoscopy
exam. It might provide another opportunity toward better diagnosis with this technology.
However, I have several questions:
1.In the WLI group, do you have indigocarmine spray? In the conventional 2D observation, it
is difficult to delineate, and determine the morphology without chromoendoscopy. I think it is
more meaningful to compare the efficacy in the presence of chromoendoscopy.
2.Have you compared the group A and group B (differed by the chronology of 2D/3D images)
for the difference? Since it a cross-over study, it may be important to see if different study
protocol would have influenced the outcomes.
3.How do you determine the "correct" morphology of the lesions in this study? The morphologic
classification systems such as Paris classification are notorious for discrepancy in determine the
flat/depressed lesions even among experts. This is also true in this study that the flat/depressed
lesions have suboptimal accuracy with the aids of 3D image and NBI. I do believe 3D image
can be more accurate in morphology, but the question need to be answered for the validity of
this analysis.
Please review this paper.
user
Title: Three-dimensional visualization improves the endoscopic diagnosis of superficial gastric
neoplasia
Version: 1 Date: 09 Feb 2021
Reviewer's report:
In this article, Higuchi et al. explorated the usefulness of 3D images in delineation and
determining the morphology for early gastric cancers.  I think this topic is very interesting and
clinically important because early gastric cancer is difficult to be detected in routine endoscopy
exam. It might provide another opportunity toward better diagnosis with this technology.
However, I have several questions:
1.In the WLI group, do you have indigocarmine spray? In the conventional 2D observation, it
is difficult to delineate, and determine the morphology without chromoendoscopy. I think it is
more meaningful to compare the efficacy in the presence of chromoendoscopy.
2.Have you compared the group A and group B (differed by the chronology of 2D/3D images)
for the difference? Since it a cross-over study, it may be important to see if different study
protocol would have influenced the outcomes.
3.How do you determine the "correct" morphology of the lesions in this study? The morphologic
classification systems such as Paris classification are notorious for discrepancy in determine the
flat/depressed lesions even among experts. This is also true in this study that the flat/depressed
lesions have suboptimal accuracy with the aids of 3D image and NBI. I do believe 3D image
can be more accurate in morphology, but the question need to be answered for the validity of
this analysis.
assistant