Title: INTRAVENOUS SEDATION DURING ESOPHAGOGASTRODUODENOSCOPY IS
ASSOCIATED WITH A REDUCED RISK OF MISSED GASTRIC CANCER
Version: 1 Date: 12 Mar 2025
Reviewer's report:
The manuscript is assessing relevant topic namely risk factors missed gastric cancer. It is a
retrospective study with obvious limitations due to study design, however I have some concerns
that need to addressed.
Major
1. In the methods section there is stated “A total of 351 patients with biopsies positive for GC
were identified (adenocarcinoma, lymphoma, and gastrointestinal stromal tumours [GISTs])” –
does it mean that lymphomas and GISTS were also calculated? Both of them are not cancers
with different biology and should not be calculated as GC in such a study (single center not
registry based study). Also stated tumor related variables such as intestinal metaplasia is a risk
factor of non- cardia adenocarcinoma.
2. For survival analysis only adenocarcinoma was taken into account – what is the rationale for
that?
3. Were gastric neuroendocrine tumors assessed?
4. The histopathology of GC is not clearly stated – the classification that was used should be
added (Lauren/WHO?) and the data should be added to table 1.
5. Was non-cardia gastric cancer assessed with or without cardia cancer? It should be clearly
written as different risk factors are related with both types of tumors.
6. The location of tumors should not combine antrum with body and cardia and fundus – it
should be antrum; corpus; fundus; cardia. Especially when location in corpus was previously
identified risk factor of MGC.
7. Are there information regarding reasons for surgery resulting in anastomosis and time of the
surgery? Perhaps high rate of cancers in anastomosis is a result of non-radical surgery of GC?
It should be discussed.
8. The information regarding histopathology of GC should be added to table 3.
9. Were the sedation administered by anesthesiologists of endoscopists? As the manuscript is
assessing sedation impact on MGC it should be precisely written how and who administered
(which) drugs.
10. One of the most important information is based on regression analysis – it is not clear how it
was performed and which and how the variables were selected. Results should be summarized
in the table.
11. There is mentioned that food residues were assessed, however no scale for that has been
used (obviously as for that time when the scales were not validated). It should be discussed in
discussion section (PEACE/Polprep/Barcelona scale/Garce scales should added to the references
and be discussed).
Minor
1. Abstract – the conclusion must not state that biopsies are needed from the anastomosis rather
precise inspection of anastomosis.
2. The sentence “The percentage of new cases of GC among a total of 36 new cases of cancer
combined at any site in 185 countries (GLOBOCAN estimates in 2020) was 5.6%.” should be
rephrased.
3. “Variously, patients underwent an insufficient number of biopsies (< 6); or  had food residue
scraps, saliva or mucus on the gastric surface; or had previous treatment with proton pump
inhibitors (PPIs); or had a gastric location; or lacked warning symptoms; or were affected by
some other identifiable factor (9,11,14).” Please provide reference for PPI and saliva or mucus.
Phrase “gastric location” is odd I believe the authors meant location of the lesion in gastric body?
4.  Methods “Olympus-GIF-Q190; or standard definition, Olympus-GIF-Q145/165)” i belive
that there is mistake – it should be GIF-HQ190.
5. Table 1 –„metaplasia” means intestinal metaplasia?
Title: INTRAVENOUS SEDATION DURING ESOPHAGOGASTRODUODENOSCOPY IS
ASSOCIATED WITH A REDUCED RISK OF MISSED GASTRIC CANCER
Version: 1 Date: 12 Mar 2025
Reviewer's report:
The manuscript is assessing relevant topic namely risk factors missed gastric cancer. It is a
retrospective study with obvious limitations due to study design, however I have some concerns
that need to addressed.
Major
1. In the methods section there is stated “A total of 351 patients with biopsies positive for GC
were identified (adenocarcinoma, lymphoma, and gastrointestinal stromal tumours [GISTs])” –
does it mean that lymphomas and GISTS were also calculated? Both of them are not cancers
with different biology and should not be calculated as GC in such a study (single center not
registry based study). Also stated tumor related variables such as intestinal metaplasia is a risk
factor of non- cardia adenocarcinoma.
2. For survival analysis only adenocarcinoma was taken into account – what is the rationale for
that?
3. Were gastric neuroendocrine tumors assessed?
4. The histopathology of GC is not clearly stated – the classification that was used should be
added (Lauren/WHO?) and the data should be added to table 1.
5. Was non-cardia gastric cancer assessed with or without cardia cancer? It should be clearly
written as different risk factors are related with both types of tumors.
6. The location of tumors should not combine antrum with body and cardia and fundus – it
should be antrum; corpus; fundus; cardia. Especially when location in corpus was previously
identified risk factor of MGC.
7. Are there information regarding reasons for surgery resulting in anastomosis and time of the
surgery? Perhaps high rate of cancers in anastomosis is a result of non-radical surgery of GC?
It should be discussed.
8. The information regarding histopathology of GC should be added to table 3.
9. Were the sedation administered by anesthesiologists of endoscopists? As the manuscript is
assessing sedation impact on MGC it should be precisely written how and who administered
(which) drugs.
10. One of the most important information is based on regression analysis – it is not clear how it
was performed and which and how the variables were selected. Results should be summarized
in the table.
11. There is mentioned that food residues were assessed, however no scale for that has been
used (obviously as for that time when the scales were not validated). It should be discussed in
discussion section (PEACE/Polprep/Barcelona scale/Garce scales should added to the references
and be discussed).
Minor
1. Abstract – the conclusion must not state that biopsies are needed from the anastomosis rather
precise inspection of anastomosis.
2. The sentence “The percentage of new cases of GC among a total of 36 new cases of cancer
combined at any site in 185 countries (GLOBOCAN estimates in 2020) was 5.6%.” should be
rephrased.
3. “Variously, patients underwent an insufficient number of biopsies (< 6); or  had food residue
scraps, saliva or mucus on the gastric surface; or had previous treatment with proton pump
inhibitors (PPIs); or had a gastric location; or lacked warning symptoms; or were affected by
some other identifiable factor (9,11,14).” Please provide reference for PPI and saliva or mucus.
Phrase “gastric location” is odd I believe the authors meant location of the lesion in gastric body?
4.  Methods “Olympus-GIF-Q190; or standard definition, Olympus-GIF-Q145/165)” i belive
that there is mistake – it should be GIF-HQ190.
5. Table 1 –„metaplasia” means intestinal metaplasia?
Please review this paper.
user
Title: INTRAVENOUS SEDATION DURING ESOPHAGOGASTRODUODENOSCOPY IS
ASSOCIATED WITH A REDUCED RISK OF MISSED GASTRIC CANCER
Version: 1 Date: 12 Mar 2025
Reviewer's report:
The manuscript is assessing relevant topic namely risk factors missed gastric cancer. It is a
retrospective study with obvious limitations due to study design, however I have some concerns
that need to addressed.
Major
1. In the methods section there is stated “A total of 351 patients with biopsies positive for GC
were identified (adenocarcinoma, lymphoma, and gastrointestinal stromal tumours [GISTs])” –
does it mean that lymphomas and GISTS were also calculated? Both of them are not cancers
with different biology and should not be calculated as GC in such a study (single center not
registry based study). Also stated tumor related variables such as intestinal metaplasia is a risk
factor of non- cardia adenocarcinoma.
2. For survival analysis only adenocarcinoma was taken into account – what is the rationale for
that?
3. Were gastric neuroendocrine tumors assessed?
4. The histopathology of GC is not clearly stated – the classification that was used should be
added (Lauren/WHO?) and the data should be added to table 1.
5. Was non-cardia gastric cancer assessed with or without cardia cancer? It should be clearly
written as different risk factors are related with both types of tumors.
6. The location of tumors should not combine antrum with body and cardia and fundus – it
should be antrum; corpus; fundus; cardia. Especially when location in corpus was previously
identified risk factor of MGC.
7. Are there information regarding reasons for surgery resulting in anastomosis and time of the
surgery? Perhaps high rate of cancers in anastomosis is a result of non-radical surgery of GC?
It should be discussed.
8. The information regarding histopathology of GC should be added to table 3.
9. Were the sedation administered by anesthesiologists of endoscopists? As the manuscript is
assessing sedation impact on MGC it should be precisely written how and who administered
(which) drugs.
10. One of the most important information is based on regression analysis – it is not clear how it
was performed and which and how the variables were selected. Results should be summarized
in the table.
11. There is mentioned that food residues were assessed, however no scale for that has been
used (obviously as for that time when the scales were not validated). It should be discussed in
discussion section (PEACE/Polprep/Barcelona scale/Garce scales should added to the references
and be discussed).
Minor
1. Abstract – the conclusion must not state that biopsies are needed from the anastomosis rather
precise inspection of anastomosis.
2. The sentence “The percentage of new cases of GC among a total of 36 new cases of cancer
combined at any site in 185 countries (GLOBOCAN estimates in 2020) was 5.6%.” should be
rephrased.
3. “Variously, patients underwent an insufficient number of biopsies (< 6); or  had food residue
scraps, saliva or mucus on the gastric surface; or had previous treatment with proton pump
inhibitors (PPIs); or had a gastric location; or lacked warning symptoms; or were affected by
some other identifiable factor (9,11,14).” Please provide reference for PPI and saliva or mucus.
Phrase “gastric location” is odd I believe the authors meant location of the lesion in gastric body?
4.  Methods “Olympus-GIF-Q190; or standard definition, Olympus-GIF-Q145/165)” i belive
that there is mistake – it should be GIF-HQ190.
5. Table 1 –„metaplasia” means intestinal metaplasia?
assistant