Title: Long Transparent Cap-Assisted Clip Closure Technique: A New Choice for
Gastrointestinal Defect Closure
Version: 2 Date: 01 Feb 2025
Reviewer's report:
This study evaluates the safety and effectiveness of the novel long transparent cap-assisted
clip closure technique (LTCCC) for closing gastrointestinal defects after endoscopic resection
(ER) of gastric submucosal tumors. Patients were divided into two groups: LTCCC and Purse-
String Suture (PSS). Both groups had a 100% closure success rate, but the closure time was
significantly shorter in the LTCCC group (17.44 minutes) compared to the PSS group (28.81
minutes). There were no significant differences between the two groups regarding postoperative
hospital stays or adverse events. During a median follow-up of 32 months, no complications
such as tumor recurrence, metastasis, or gastrointestinal fistulae were observed. The LTCCC
technique is considered a simple, safe, and effective option for closing gastrointestinal defects.
The authors mention other closure techniques like OTSC and OverStitch but do not provide
a thorough comparison in terms of safety, effectiveness, and clinical applicability. While they
state that these techniques are less commonly used in clinical practice in Asian countries, they
could provide more context as to why those techniques are not suitable for certain patients or
regions. A more detailed analysis of these alternatives would strengthen the argument for the
LTCCC technique as the preferred method.
The authors acknowledge that the LTCCC technique may offer a more secure closure than
the PSS method, but they also mention the theoretical risk of clip detachment under certain
conditions. This is an important point that could be expanded upon. How often do such risks
occur in practice? Can this potential issue be mitigated further with any modifications to the
technique? It would be helpful if the authors discussed how frequently this has been observed
in their cohort or referenced data from other studies to support or alleviate this concern.
The authors mention that less experienced physicians can become proficient with short-term
training, which is a positive aspect of the LTCCC technique. However, they do not discuss the
variability in the skill level of operators in their study. Given that the technique's success is
largely dependent on the physician's skills, further elaboration on how physician experience or
training might influence outcomes would be valuable. Were there any challenges or learning
curves observed in this study, and if so, how were they addressed?
Some sections of the discussion could be more concise. For example, the extended explanation
about the disadvantages of the PSS technique is somewhat repetitive and could be streamlined
for better clarity. A clearer focus on the main findings and their implications would improve the
readability of the discussion.
Title: Long Transparent Cap-Assisted Clip Closure Technique: A New Choice for
Gastrointestinal Defect Closure
Version: 2 Date: 01 Feb 2025
Reviewer's report:
This study evaluates the safety and effectiveness of the novel long transparent cap-assisted
clip closure technique (LTCCC) for closing gastrointestinal defects after endoscopic resection
(ER) of gastric submucosal tumors. Patients were divided into two groups: LTCCC and Purse-
String Suture (PSS). Both groups had a 100% closure success rate, but the closure time was
significantly shorter in the LTCCC group (17.44 minutes) compared to the PSS group (28.81
minutes). There were no significant differences between the two groups regarding postoperative
hospital stays or adverse events. During a median follow-up of 32 months, no complications
such as tumor recurrence, metastasis, or gastrointestinal fistulae were observed. The LTCCC
technique is considered a simple, safe, and effective option for closing gastrointestinal defects.
The authors mention other closure techniques like OTSC and OverStitch but do not provide
a thorough comparison in terms of safety, effectiveness, and clinical applicability. While they
state that these techniques are less commonly used in clinical practice in Asian countries, they
could provide more context as to why those techniques are not suitable for certain patients or
regions. A more detailed analysis of these alternatives would strengthen the argument for the
LTCCC technique as the preferred method.
The authors acknowledge that the LTCCC technique may offer a more secure closure than
the PSS method, but they also mention the theoretical risk of clip detachment under certain
conditions. This is an important point that could be expanded upon. How often do such risks
occur in practice? Can this potential issue be mitigated further with any modifications to the
technique? It would be helpful if the authors discussed how frequently this has been observed
in their cohort or referenced data from other studies to support or alleviate this concern.
The authors mention that less experienced physicians can become proficient with short-term
training, which is a positive aspect of the LTCCC technique. However, they do not discuss the
variability in the skill level of operators in their study. Given that the technique's success is
largely dependent on the physician's skills, further elaboration on how physician experience or
training might influence outcomes would be valuable. Were there any challenges or learning
curves observed in this study, and if so, how were they addressed?
Some sections of the discussion could be more concise. For example, the extended explanation
about the disadvantages of the PSS technique is somewhat repetitive and could be streamlined
for better clarity. A clearer focus on the main findings and their implications would improve the
readability of the discussion.
Please review this paper.
user
Title: Long Transparent Cap-Assisted Clip Closure Technique: A New Choice for
Gastrointestinal Defect Closure
Version: 2 Date: 01 Feb 2025
Reviewer's report:
This study evaluates the safety and effectiveness of the novel long transparent cap-assisted
clip closure technique (LTCCC) for closing gastrointestinal defects after endoscopic resection
(ER) of gastric submucosal tumors. Patients were divided into two groups: LTCCC and Purse-
String Suture (PSS). Both groups had a 100% closure success rate, but the closure time was
significantly shorter in the LTCCC group (17.44 minutes) compared to the PSS group (28.81
minutes). There were no significant differences between the two groups regarding postoperative
hospital stays or adverse events. During a median follow-up of 32 months, no complications
such as tumor recurrence, metastasis, or gastrointestinal fistulae were observed. The LTCCC
technique is considered a simple, safe, and effective option for closing gastrointestinal defects.
The authors mention other closure techniques like OTSC and OverStitch but do not provide
a thorough comparison in terms of safety, effectiveness, and clinical applicability. While they
state that these techniques are less commonly used in clinical practice in Asian countries, they
could provide more context as to why those techniques are not suitable for certain patients or
regions. A more detailed analysis of these alternatives would strengthen the argument for the
LTCCC technique as the preferred method.
The authors acknowledge that the LTCCC technique may offer a more secure closure than
the PSS method, but they also mention the theoretical risk of clip detachment under certain
conditions. This is an important point that could be expanded upon. How often do such risks
occur in practice? Can this potential issue be mitigated further with any modifications to the
technique? It would be helpful if the authors discussed how frequently this has been observed
in their cohort or referenced data from other studies to support or alleviate this concern.
The authors mention that less experienced physicians can become proficient with short-term
training, which is a positive aspect of the LTCCC technique. However, they do not discuss the
variability in the skill level of operators in their study. Given that the technique's success is
largely dependent on the physician's skills, further elaboration on how physician experience or
training might influence outcomes would be valuable. Were there any challenges or learning
curves observed in this study, and if so, how were they addressed?
Some sections of the discussion could be more concise. For example, the extended explanation
about the disadvantages of the PSS technique is somewhat repetitive and could be streamlined
for better clarity. A clearer focus on the main findings and their implications would improve the
readability of the discussion.
assistant