Reviewer’s report
Title: 
A novel capsule endoscopy for upper and mid-GI tract: the UMGI capsule
Version: 
1 
Date: 
03 Feb 2023
Reviewer's report:
Manuscript: BMGE-D-22-00386R1
Full Title: A novel capsule endoscopy for upper and mid GI tract: the UMGI
capsule
This pilot study assessed the feasibility and safety of a new capsule endoscopy
system designed to ameliorate the evaluation of upper g.i. tract via magnet and
string control, and small bowel after device detachment in duodenum.
The field is of great interest since minimally invasive procedure as well as
optimization of g.i. tract exploration are desirable.
The papers has been reviewed by 2 reviewers and authors provided a point-by-
point reply to reviewers' comments
However, there are still some issues to be addressed
MAJOR COMMENTS:
1. Authors still emphasized the utility of the device in exploring upper g.i tract,
their primary study outcome. Except for the reverse view of the duodenum - as
underlined by authors - this device is of difficult comparison with a "traditional"
upper gi endoscopy, 
in absence of inflation, aspiration, washing, targeted
biopsies. 
2. In their conclusion, authors suggest use of the device in patients taking
antithrombotic drugs, however antithrombotic therapy (as well as
anticoagulation) is not a contraindication to upper g.i. endoscopy
3. The described procedure implies patient swallowing the device in left lateral
position and required thereafter repeated water ingestions. This may raise some
safety issues: was the position maintained during water ingestion? did the
authors observed inhalation episodes? which position was required during the
entire duration of the procedure?
4. At the moment, based upon their data, their device - proposed to study the
upper g.i. tract - does not seem to offer a real advantage compared to the
"traditional " upper gi endoscopy, excdept for the reverse view of duodenum.
Therefore in my opinion the technique is promising but authors should carefully
specify that at the moment is not yet comparable to upper gi endoscopy and
could be limited to a subgroup of patients unwilling to undergo traditional
endoscopy.
Thus, should again adjust their conclusions and better underline the limits of the
technique. 
MINOR COMMENTS
1. The primary study outcome was to assess the technical success of th e device.
However, small bowel exploration, which is the main indication for capsule
endoscopy, is still not well described. Markers for complete small bowel
visualization should be mentioned. Furthermore, it is unclear whether they use
the magnet tool to ameliorate small bowel visualization. 
2. Page 5 line 42: are subjects without gastrointestinal symtoms healthy
volunteers? 
this should be specified.
3. Page 10 line 509-53: lymphangiectasia are mentioned twice after the text
revision, while angiodysplasia "disappeared": "four lymphangiectasia, one
xantoma and three angiodysplasia lymphangiectasia". 
Please specifiy the correct
results. 
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' below
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Web of Science Reviewer Recognition
. Springer Nature can send verification
of this review directly to a Web of Science researcher profile (a subsidiary of
Clarivate Analytics). If you would like to take advantage of this service, please
click on the “Yes” option below. Your name, email address, title of the reviewed
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“Review Data”) will then be transmitted to Web of Science after the final
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Web of Science for a 
Web of Science researcher profile (this service was
previously known as “Publons”), they will notify you of the receipt of this
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you to register in order for them to be able to recognize your review on your new
profile page. Web of Science may use the Review Data to generate derivative
metadata for the benefit of Web of Science and you as a reviewer, carefully
considering the sensitivity of such information. For example, Web of Science
may verify your record as a reviewer by updating your profile published on its
webservice if you have registered for such service or help editors to identify
candidate reviewers. Please find the details of processing in Web of Science’s
privacy policy 
https://clarivate.com/privacy-center/notices-policies/privacy-
policy/
Yes
Reviewer’s report
Title: 
A novel capsule endoscopy for upper and mid-GI tract: the UMGI capsule
Version: 
1 
Date: 
03 Feb 2023
Reviewer's report:
Manuscript: BMGE-D-22-00386R1
Full Title: A novel capsule endoscopy for upper and mid GI tract: the UMGI
capsule
This pilot study assessed the feasibility and safety of a new capsule endoscopy
system designed to ameliorate the evaluation of upper g.i. tract via magnet and
string control, and small bowel after device detachment in duodenum.
The field is of great interest since minimally invasive procedure as well as
optimization of g.i. tract exploration are desirable.
The papers has been reviewed by 2 reviewers and authors provided a point-by-
point reply to reviewers' comments
However, there are still some issues to be addressed
MAJOR COMMENTS:
1. Authors still emphasized the utility of the device in exploring upper g.i tract,
their primary study outcome. Except for the reverse view of the duodenum - as
underlined by authors - this device is of difficult comparison with a "traditional"
upper gi endoscopy, 
in absence of inflation, aspiration, washing, targeted
biopsies. 
2. In their conclusion, authors suggest use of the device in patients taking
antithrombotic drugs, however antithrombotic therapy (as well as
anticoagulation) is not a contraindication to upper g.i. endoscopy
3. The described procedure implies patient swallowing the device in left lateral
position and required thereafter repeated water ingestions. This may raise some
safety issues: was the position maintained during water ingestion? did the
authors observed inhalation episodes? which position was required during the
entire duration of the procedure?
4. At the moment, based upon their data, their device - proposed to study the
upper g.i. tract - does not seem to offer a real advantage compared to the
"traditional " upper gi endoscopy, excdept for the reverse view of duodenum.
Therefore in my opinion the technique is promising but authors should carefully
specify that at the moment is not yet comparable to upper gi endoscopy and
could be limited to a subgroup of patients unwilling to undergo traditional
endoscopy.
Thus, should again adjust their conclusions and better underline the limits of the
technique. 
MINOR COMMENTS
1. The primary study outcome was to assess the technical success of th e device.
However, small bowel exploration, which is the main indication for capsule
endoscopy, is still not well described. Markers for complete small bowel
visualization should be mentioned. Furthermore, it is unclear whether they use
the magnet tool to ameliorate small bowel visualization. 
2. Page 5 line 42: are subjects without gastrointestinal symtoms healthy
volunteers? 
this should be specified.
3. Page 10 line 509-53: lymphangiectasia are mentioned twice after the text
revision, while angiodysplasia "disappeared": "four lymphangiectasia, one
xantoma and three angiodysplasia lymphangiectasia". 
Please specifiy the correct
results. 
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' below
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Web of Science Reviewer Recognition
. Springer Nature can send verification
of this review directly to a Web of Science researcher profile (a subsidiary of
Clarivate Analytics). If you would like to take advantage of this service, please
click on the “Yes” option below. Your name, email address, title of the reviewed
manuscript, name of the journal, and date of your review submission (the
“Review Data”) will then be transmitted to Web of Science after the final
decision on the manuscript has been made. If you have already registered with
Web of Science for a 
Web of Science researcher profile (this service was
previously known as “Publons”), they will notify you of the receipt of this
review and update your profile as per your settings and their policy. If you are
not registered with Web of Science, you will receive an email from them asking
you to register in order for them to be able to recognize your review on your new
profile page. Web of Science may use the Review Data to generate derivative
metadata for the benefit of Web of Science and you as a reviewer, carefully
considering the sensitivity of such information. For example, Web of Science
may verify your record as a reviewer by updating your profile published on its
webservice if you have registered for such service or help editors to identify
candidate reviewers. Please find the details of processing in Web of Science’s
privacy policy 
https://clarivate.com/privacy-center/notices-policies/privacy-
policy/
Yes
Please review this paper.
user
Reviewer’s report
Title: 
A novel capsule endoscopy for upper and mid-GI tract: the UMGI capsule
Version: 
1 
Date: 
03 Feb 2023
Reviewer's report:
Manuscript: BMGE-D-22-00386R1
Full Title: A novel capsule endoscopy for upper and mid GI tract: the UMGI
capsule
This pilot study assessed the feasibility and safety of a new capsule endoscopy
system designed to ameliorate the evaluation of upper g.i. tract via magnet and
string control, and small bowel after device detachment in duodenum.
The field is of great interest since minimally invasive procedure as well as
optimization of g.i. tract exploration are desirable.
The papers has been reviewed by 2 reviewers and authors provided a point-by-
point reply to reviewers' comments
However, there are still some issues to be addressed
MAJOR COMMENTS:
1. Authors still emphasized the utility of the device in exploring upper g.i tract,
their primary study outcome. Except for the reverse view of the duodenum - as
underlined by authors - this device is of difficult comparison with a "traditional"
upper gi endoscopy, 
in absence of inflation, aspiration, washing, targeted
biopsies. 
2. In their conclusion, authors suggest use of the device in patients taking
antithrombotic drugs, however antithrombotic therapy (as well as
anticoagulation) is not a contraindication to upper g.i. endoscopy
3. The described procedure implies patient swallowing the device in left lateral
position and required thereafter repeated water ingestions. This may raise some
safety issues: was the position maintained during water ingestion? did the
authors observed inhalation episodes? which position was required during the
entire duration of the procedure?
4. At the moment, based upon their data, their device - proposed to study the
upper g.i. tract - does not seem to offer a real advantage compared to the
"traditional " upper gi endoscopy, excdept for the reverse view of duodenum.
Therefore in my opinion the technique is promising but authors should carefully
specify that at the moment is not yet comparable to upper gi endoscopy and
could be limited to a subgroup of patients unwilling to undergo traditional
endoscopy.
Thus, should again adjust their conclusions and better underline the limits of the
technique. 
MINOR COMMENTS
1. The primary study outcome was to assess the technical success of th e device.
However, small bowel exploration, which is the main indication for capsule
endoscopy, is still not well described. Markers for complete small bowel
visualization should be mentioned. Furthermore, it is unclear whether they use
the magnet tool to ameliorate small bowel visualization. 
2. Page 5 line 42: are subjects without gastrointestinal symtoms healthy
volunteers? 
this should be specified.
3. Page 10 line 509-53: lymphangiectasia are mentioned twice after the text
revision, while angiodysplasia "disappeared": "four lymphangiectasia, one
xantoma and three angiodysplasia lymphangiectasia". 
Please specifiy the correct
results. 
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' below
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Web of Science Reviewer Recognition
. Springer Nature can send verification
of this review directly to a Web of Science researcher profile (a subsidiary of
Clarivate Analytics). If you would like to take advantage of this service, please
click on the “Yes” option below. Your name, email address, title of the reviewed
manuscript, name of the journal, and date of your review submission (the
“Review Data”) will then be transmitted to Web of Science after the final
decision on the manuscript has been made. If you have already registered with
Web of Science for a 
Web of Science researcher profile (this service was
previously known as “Publons”), they will notify you of the receipt of this
review and update your profile as per your settings and their policy. If you are
not registered with Web of Science, you will receive an email from them asking
you to register in order for them to be able to recognize your review on your new
profile page. Web of Science may use the Review Data to generate derivative
metadata for the benefit of Web of Science and you as a reviewer, carefully
considering the sensitivity of such information. For example, Web of Science
may verify your record as a reviewer by updating your profile published on its
webservice if you have registered for such service or help editors to identify
candidate reviewers. Please find the details of processing in Web of Science’s
privacy policy 
https://clarivate.com/privacy-center/notices-policies/privacy-
policy/
Yes
assistant