Reviewer’s report
Title: Direct endoscopic full-thickness resection for submucosal tumors with an intraluminal growth
pattern originating from the muscularis propria layer in the gastric fundus
Version: 0 Date: 23 Oct 2019
Reviewer: Wei Gong
Reviewer's report:
Endoscopic  full-thickness  resection  (EFTR)usually  is  uesed  to  resect  the   submucosal  tumors
originating from the muscularis propria layer in the gastric fundus.   However, it is difficult to perform
in a retroflexed fashion in the gastric fundus indeed. This study propose a innovating idea that  direct
EFTR  could  be a simple, effective and safe procedure to treat intraluminal-growth submucosal tumors
originating from the muscularis propria. Compared to traditional EFTR,  diagram showed the same
effect and safety, while taking much more shorter operative time. However, there are two minor
revisions recommended:
1. It would be better if the baseline  in terms of the patients age  ，tumor size etc and operation
characteristics included in one table with statistics.    
2. Intraluminal-growth shoud be clearly defined  ，it would be better defined with adiagram.
3. In the result part ，the authors state that they  confirmed the Intraluminal-growth by EUS. In fact ，
for larger tumors，EUS is not enough to confirm the Intraluminal-growth. CT should be used a
combination with EUS to evaluate. Therefore  ，in the methods part ，the author should state cearly how
the Intraluminal-growth was evaluated.
4. Direct EFTR steps presented with a diagram will be better understand by readers.
Are the methods appropriate and well 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 conclusions 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 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 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 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 below.
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 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 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: Direct endoscopic full-thickness resection for submucosal tumors with an intraluminal growth
pattern originating from the muscularis propria layer in the gastric fundus
Version: 0 Date: 23 Oct 2019
Reviewer: Wei Gong
Reviewer's report:
Endoscopic  full-thickness  resection  (EFTR)usually  is  uesed  to  resect  the   submucosal  tumors
originating from the muscularis propria layer in the gastric fundus.   However, it is difficult to perform
in a retroflexed fashion in the gastric fundus indeed. This study propose a innovating idea that  direct
EFTR  could  be a simple, effective and safe procedure to treat intraluminal-growth submucosal tumors
originating from the muscularis propria. Compared to traditional EFTR,  diagram showed the same
effect and safety, while taking much more shorter operative time. However, there are two minor
revisions recommended:
1. It would be better if the baseline  in terms of the patients age  ，tumor size etc and operation
characteristics included in one table with statistics.    
2. Intraluminal-growth shoud be clearly defined  ，it would be better defined with adiagram.
3. In the result part ，the authors state that they  confirmed the Intraluminal-growth by EUS. In fact ，
for larger tumors，EUS is not enough to confirm the Intraluminal-growth. CT should be used a
combination with EUS to evaluate. Therefore  ，in the methods part ，the author should state cearly how
the Intraluminal-growth was evaluated.
4. Direct EFTR steps presented with a diagram will be better understand by readers.
Are the methods appropriate and well 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 conclusions 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 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 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 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 below.
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 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 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: Direct endoscopic full-thickness resection for submucosal tumors with an intraluminal growth
pattern originating from the muscularis propria layer in the gastric fundus
Version: 0 Date: 23 Oct 2019
Reviewer: Wei Gong
Reviewer's report:
Endoscopic  full-thickness  resection  (EFTR)usually  is  uesed  to  resect  the   submucosal  tumors
originating from the muscularis propria layer in the gastric fundus.   However, it is difficult to perform
in a retroflexed fashion in the gastric fundus indeed. This study propose a innovating idea that  direct
EFTR  could  be a simple, effective and safe procedure to treat intraluminal-growth submucosal tumors
originating from the muscularis propria. Compared to traditional EFTR,  diagram showed the same
effect and safety, while taking much more shorter operative time. However, there are two minor
revisions recommended:
1. It would be better if the baseline  in terms of the patients age  ，tumor size etc and operation
characteristics included in one table with statistics.    
2. Intraluminal-growth shoud be clearly defined  ，it would be better defined with adiagram.
3. In the result part ，the authors state that they  confirmed the Intraluminal-growth by EUS. In fact ，
for larger tumors，EUS is not enough to confirm the Intraluminal-growth. CT should be used a
combination with EUS to evaluate. Therefore  ，in the methods part ，the author should state cearly how
the Intraluminal-growth was evaluated.
4. Direct EFTR steps presented with a diagram will be better understand by readers.
Are the methods appropriate and well 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 conclusions 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 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 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 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 below.
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 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 as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal
assistant