Title: Biopsy in emergency gastroscopy does not increase the risk of rebleeding in patients with
Forrest I acute nonvariceal upper gastrointestinal bleeding combined with suspected malignant
gastric ulcer: a multicenter retrospective cohort study
Version: 3 Date: 30 Apr 2021
Reviewer's report:
Review on the paper by Quchuan Zhao and Tianyu Chi.
In this paper authors used a propensity score matching to compare the risk of rebleeding and the
cost in patients presenting with Forest 1 gastric ulcer of suspected malignant origin according
to the realization of biopsies.
They suggest that there is no increased risk of bleeding and no cost increase.
I must say that I am quite confuse with the structure of the paper.
Indeed it is quite unusual to have rebleeding as primary outcome and cost as secondary. Nothing
ius told about the cost analysis so validity of results presented cannot be ascertained.
The matching procedure should have been more detailed.
Same is for the rebleeding ascertainment, what if the definition of “vital sign instability
and a significant drop in hemoglobin”. Nothing is told about threshold value, or if authors
reconstructed rebleeding cases based on individual patient’s data analysis (Hb or blood pressure
values) or just based on hospital reports.
If rebleeding was not just based on a specific code, I hope the occurrence of the event was
assessed blinded to the knowledge that a biopsy was performed or not.
Some of the results presented on table one are contra intuitive, for example the higher proportion
of patients on clopidogrel in the biopsy versus non biopsy group both before (17% vs 6.6%) and
after matching (18.5% vs 13.9%). Same is true for size of the ulcer, higher proportion of small
ulcers in the non-biopsy than in the biopsy group.
Even if statistical significance is not reached is seems surprising that point estimates for
rebleeding are lower in ASA and clopidogrel users than in non-users
It would have been of interest to give explanation on the reasons associated with biopsies being
performed or not.
I don't really understand how pathology results can be provided in the group of patients who
did not have biopsies.
The first two paragraphs of the discussion are more appropriate, and the beginning of the third
one belongs to the method section
Title: Biopsy in emergency gastroscopy does not increase the risk of rebleeding in patients with
Forrest I acute nonvariceal upper gastrointestinal bleeding combined with suspected malignant
gastric ulcer: a multicenter retrospective cohort study
Version: 3 Date: 30 Apr 2021
Reviewer's report:
Review on the paper by Quchuan Zhao and Tianyu Chi.
In this paper authors used a propensity score matching to compare the risk of rebleeding and the
cost in patients presenting with Forest 1 gastric ulcer of suspected malignant origin according
to the realization of biopsies.
They suggest that there is no increased risk of bleeding and no cost increase.
I must say that I am quite confuse with the structure of the paper.
Indeed it is quite unusual to have rebleeding as primary outcome and cost as secondary. Nothing
ius told about the cost analysis so validity of results presented cannot be ascertained.
The matching procedure should have been more detailed.
Same is for the rebleeding ascertainment, what if the definition of “vital sign instability
and a significant drop in hemoglobin”. Nothing is told about threshold value, or if authors
reconstructed rebleeding cases based on individual patient’s data analysis (Hb or blood pressure
values) or just based on hospital reports.
If rebleeding was not just based on a specific code, I hope the occurrence of the event was
assessed blinded to the knowledge that a biopsy was performed or not.
Some of the results presented on table one are contra intuitive, for example the higher proportion
of patients on clopidogrel in the biopsy versus non biopsy group both before (17% vs 6.6%) and
after matching (18.5% vs 13.9%). Same is true for size of the ulcer, higher proportion of small
ulcers in the non-biopsy than in the biopsy group.
Even if statistical significance is not reached is seems surprising that point estimates for
rebleeding are lower in ASA and clopidogrel users than in non-users
It would have been of interest to give explanation on the reasons associated with biopsies being
performed or not.
I don't really understand how pathology results can be provided in the group of patients who
did not have biopsies.
The first two paragraphs of the discussion are more appropriate, and the beginning of the third
one belongs to the method section
Please review this paper.
user
Title: Biopsy in emergency gastroscopy does not increase the risk of rebleeding in patients with
Forrest I acute nonvariceal upper gastrointestinal bleeding combined with suspected malignant
gastric ulcer: a multicenter retrospective cohort study
Version: 3 Date: 30 Apr 2021
Reviewer's report:
Review on the paper by Quchuan Zhao and Tianyu Chi.
In this paper authors used a propensity score matching to compare the risk of rebleeding and the
cost in patients presenting with Forest 1 gastric ulcer of suspected malignant origin according
to the realization of biopsies.
They suggest that there is no increased risk of bleeding and no cost increase.
I must say that I am quite confuse with the structure of the paper.
Indeed it is quite unusual to have rebleeding as primary outcome and cost as secondary. Nothing
ius told about the cost analysis so validity of results presented cannot be ascertained.
The matching procedure should have been more detailed.
Same is for the rebleeding ascertainment, what if the definition of “vital sign instability
and a significant drop in hemoglobin”. Nothing is told about threshold value, or if authors
reconstructed rebleeding cases based on individual patient’s data analysis (Hb or blood pressure
values) or just based on hospital reports.
If rebleeding was not just based on a specific code, I hope the occurrence of the event was
assessed blinded to the knowledge that a biopsy was performed or not.
Some of the results presented on table one are contra intuitive, for example the higher proportion
of patients on clopidogrel in the biopsy versus non biopsy group both before (17% vs 6.6%) and
after matching (18.5% vs 13.9%). Same is true for size of the ulcer, higher proportion of small
ulcers in the non-biopsy than in the biopsy group.
Even if statistical significance is not reached is seems surprising that point estimates for
rebleeding are lower in ASA and clopidogrel users than in non-users
It would have been of interest to give explanation on the reasons associated with biopsies being
performed or not.
I don't really understand how pathology results can be provided in the group of patients who
did not have biopsies.
The first two paragraphs of the discussion are more appropriate, and the beginning of the third
one belongs to the method section
assistant