Reviewer's report
Title:Giant flat adenomas of rectum successfully treated in two steps by
endoscopic submucosal dissection and endoscopic mucosal resection.
Version: 1Date:9 March 2010
Reviewer: Naoto Sakamoto
Reviewer's report:
“Comments for authors”
In this manuscript, authors have claiming the effectiveness of combined
ESD/EMR resection for gastrointestinal neoplasm.
However, there are some crucial problems.
Major
1) Although authors have planned to perform ESD in all 3 cases with many
devises, they reconciled to continue ESD because of the technical difficulty and
finally performed EPMR. However, same method have already recognized as a
usual method in this field 1).
2) Authors described that they obtained the complete dissection of the polyp and
the complete histological evaluation from the piecemealed samples. I cannot
believe that it is possible to obtain the complete histological evaluation from the
rugged ulcer after tumor resection (Fig. 1-3). The rugged ulcer suggested that
many piecemeal resections might be performed and it should cause unreliable
histological evaluation because of burning effect. I think they should describe
how many piecemeal resections were performed. Also, I strongly recommend
authors to indicate restructured histological view.
Minor
1) Authors described that combined ESD/EMR resection seems effective, safe
and reliable for resection of huge gastrointestinal neoplasm. If so, what is the
control, ESD or well-planned EPMR? Authors should describe about this point
and show the data with statistical analysis.
Ref. 1) Shinji Tanaka, Shiro Oka, Iwao Kaneko, et al. Endoscopic submucosal
dissection for colorectal neoplasia: possibility of standardization
Gastrointestinal Endoscopy2007, 66, 100-107
Reviewer's report
Title:Giant flat adenomas of rectum successfully treated in two steps by
endoscopic submucosal dissection and endoscopic mucosal resection.
Version: 1Date:9 March 2010
Reviewer: Naoto Sakamoto
Reviewer's report:
“Comments for authors”
In this manuscript, authors have claiming the effectiveness of combined
ESD/EMR resection for gastrointestinal neoplasm.
However, there are some crucial problems.
Major
1) Although authors have planned to perform ESD in all 3 cases with many
devises, they reconciled to continue ESD because of the technical difficulty and
finally performed EPMR. However, same method have already recognized as a
usual method in this field 1).
2) Authors described that they obtained the complete dissection of the polyp and
the complete histological evaluation from the piecemealed samples. I cannot
believe that it is possible to obtain the complete histological evaluation from the
rugged ulcer after tumor resection (Fig. 1-3). The rugged ulcer suggested that
many piecemeal resections might be performed and it should cause unreliable
histological evaluation because of burning effect. I think they should describe
how many piecemeal resections were performed. Also, I strongly recommend
authors to indicate restructured histological view.
Minor
1) Authors described that combined ESD/EMR resection seems effective, safe
and reliable for resection of huge gastrointestinal neoplasm. If so, what is the
control, ESD or well-planned EPMR? Authors should describe about this point
and show the data with statistical analysis.
Ref. 1) Shinji Tanaka, Shiro Oka, Iwao Kaneko, et al. Endoscopic submucosal
dissection for colorectal neoplasia: possibility of standardization
Gastrointestinal Endoscopy2007, 66, 100-107
Please review this paper.
user
Reviewer's report
Title:Giant flat adenomas of rectum successfully treated in two steps by
endoscopic submucosal dissection and endoscopic mucosal resection.
Version: 1Date:9 March 2010
Reviewer: Naoto Sakamoto
Reviewer's report:
“Comments for authors”
In this manuscript, authors have claiming the effectiveness of combined
ESD/EMR resection for gastrointestinal neoplasm.
However, there are some crucial problems.
Major
1) Although authors have planned to perform ESD in all 3 cases with many
devises, they reconciled to continue ESD because of the technical difficulty and
finally performed EPMR. However, same method have already recognized as a
usual method in this field 1).
2) Authors described that they obtained the complete dissection of the polyp and
the complete histological evaluation from the piecemealed samples. I cannot
believe that it is possible to obtain the complete histological evaluation from the
rugged ulcer after tumor resection (Fig. 1-3). The rugged ulcer suggested that
many piecemeal resections might be performed and it should cause unreliable
histological evaluation because of burning effect. I think they should describe
how many piecemeal resections were performed. Also, I strongly recommend
authors to indicate restructured histological view.
Minor
1) Authors described that combined ESD/EMR resection seems effective, safe
and reliable for resection of huge gastrointestinal neoplasm. If so, what is the
control, ESD or well-planned EPMR? Authors should describe about this point
and show the data with statistical analysis.
Ref. 1) Shinji Tanaka, Shiro Oka, Iwao Kaneko, et al. Endoscopic submucosal
dissection for colorectal neoplasia: possibility of standardization
Gastrointestinal Endoscopy2007, 66, 100-107
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