Title: Endoscopic Semi-Blunt Dissection Technique is Safe and Effective for Treating Gastric
Submucosal Tumors from The Muscularis Propria
Version: 0 Date: 19 Dec 2024
Reviewer:  Dimitrios Kehagias
Reviewer's report:
Thank you for the opportunity to review the manuscript entitled "Endoscopic Semi-Blunt
Dissection Technique is Safe and Effective for Treating Gastric Submucosal Tumors from The
Muscularis Propria". The authors have conducted a single-center retrospective comparative
study between conventional dissection and semi-blunt dissection for gastric submucosal tumors.
Below are my comments and suggestions to the authors:
1. You mention in the introduction that the semi-blunt dissection was implemented first in
your center and you gave this name to this approach. In general endoscopists do not use blunt
technique during ESD for removing the tumors?
2. Regarding the inclusion/exclusion criteria, were the submucosal tumors incidental findings
or symptomatic lesions? Also, were patients that took c-kit inhibitor (for GISTs) excluded? The
size here is far less than 5cm but perhaps some patients could have taken imatinib and reduced
the size of the tumor. Were these excluded?
3. In tables and procedures you mention endoscopic and surgical suturing. What exactly is the
difference? It is not clear in methods. Surgical suturing is the ligation device? These are both
endoscopic techniques from my point of view.
4. In the definitions you do not mention gastric wall damage. How did you evaluate gastric wall
damage? Do you mean damage to gastric mucosa propria?
5. Divide your results into two subsections. The first one should be named: “Perioperative patient
characteristics and histology of gastric submucosal tumors”. The second one: “Perioperative
patient characteristics and histology of GISTs”
6. In the beginning of the results and in the two tables, mention what your two groups are, and
the number of patients in each group.
7. How it is possible to have only 0.46 cm gastric wall damage in group B and you remove
from this defect a lesion of mean 1.95 cm? Unless you mean the damage in the gastric musoca
propria. You should clarify this.
8. In the results, rephrase the comparison between group A and B for the maximum pathological
size. How can it be greater when it is 1.26 vs 1.95? unless it is the opposite
9. In the beginning of the discussion, add a small paragraph, where you mention the findings
of your study.
10. "When excising muscularis propria tumors, novice doctors often experience a greater
psychological burden when a perforation occurs.  The proposed method is more suitable for
such doctors in excising muscularis propria tumors under endoscopic surgery because of the
increased safety following retraction of the knife tip. "
Is this based on personal experience or can you cite a reference for this conclusion?
11. Based on the two tables R1 resection occurred only in patients treated for GISTs. How did
these patients not have a recurrence? Did they take perhaps imatinib after the histology?
Overall it is a well-written manuscript in terms of clarity, language and methods enabling
reproducibility. There are only some points that need to be clarified. Thank you again.
Title: Endoscopic Semi-Blunt Dissection Technique is Safe and Effective for Treating Gastric
Submucosal Tumors from The Muscularis Propria
Version: 0 Date: 19 Dec 2024
Reviewer:  Dimitrios Kehagias
Reviewer's report:
Thank you for the opportunity to review the manuscript entitled "Endoscopic Semi-Blunt
Dissection Technique is Safe and Effective for Treating Gastric Submucosal Tumors from The
Muscularis Propria". The authors have conducted a single-center retrospective comparative
study between conventional dissection and semi-blunt dissection for gastric submucosal tumors.
Below are my comments and suggestions to the authors:
1. You mention in the introduction that the semi-blunt dissection was implemented first in
your center and you gave this name to this approach. In general endoscopists do not use blunt
technique during ESD for removing the tumors?
2. Regarding the inclusion/exclusion criteria, were the submucosal tumors incidental findings
or symptomatic lesions? Also, were patients that took c-kit inhibitor (for GISTs) excluded? The
size here is far less than 5cm but perhaps some patients could have taken imatinib and reduced
the size of the tumor. Were these excluded?
3. In tables and procedures you mention endoscopic and surgical suturing. What exactly is the
difference? It is not clear in methods. Surgical suturing is the ligation device? These are both
endoscopic techniques from my point of view.
4. In the definitions you do not mention gastric wall damage. How did you evaluate gastric wall
damage? Do you mean damage to gastric mucosa propria?
5. Divide your results into two subsections. The first one should be named: “Perioperative patient
characteristics and histology of gastric submucosal tumors”. The second one: “Perioperative
patient characteristics and histology of GISTs”
6. In the beginning of the results and in the two tables, mention what your two groups are, and
the number of patients in each group.
7. How it is possible to have only 0.46 cm gastric wall damage in group B and you remove
from this defect a lesion of mean 1.95 cm? Unless you mean the damage in the gastric musoca
propria. You should clarify this.
8. In the results, rephrase the comparison between group A and B for the maximum pathological
size. How can it be greater when it is 1.26 vs 1.95? unless it is the opposite
9. In the beginning of the discussion, add a small paragraph, where you mention the findings
of your study.
10. "When excising muscularis propria tumors, novice doctors often experience a greater
psychological burden when a perforation occurs.  The proposed method is more suitable for
such doctors in excising muscularis propria tumors under endoscopic surgery because of the
increased safety following retraction of the knife tip. "
Is this based on personal experience or can you cite a reference for this conclusion?
11. Based on the two tables R1 resection occurred only in patients treated for GISTs. How did
these patients not have a recurrence? Did they take perhaps imatinib after the histology?
Overall it is a well-written manuscript in terms of clarity, language and methods enabling
reproducibility. There are only some points that need to be clarified. Thank you again.
Please review this paper.
user
Title: Endoscopic Semi-Blunt Dissection Technique is Safe and Effective for Treating Gastric
Submucosal Tumors from The Muscularis Propria
Version: 0 Date: 19 Dec 2024
Reviewer:  Dimitrios Kehagias
Reviewer's report:
Thank you for the opportunity to review the manuscript entitled "Endoscopic Semi-Blunt
Dissection Technique is Safe and Effective for Treating Gastric Submucosal Tumors from The
Muscularis Propria". The authors have conducted a single-center retrospective comparative
study between conventional dissection and semi-blunt dissection for gastric submucosal tumors.
Below are my comments and suggestions to the authors:
1. You mention in the introduction that the semi-blunt dissection was implemented first in
your center and you gave this name to this approach. In general endoscopists do not use blunt
technique during ESD for removing the tumors?
2. Regarding the inclusion/exclusion criteria, were the submucosal tumors incidental findings
or symptomatic lesions? Also, were patients that took c-kit inhibitor (for GISTs) excluded? The
size here is far less than 5cm but perhaps some patients could have taken imatinib and reduced
the size of the tumor. Were these excluded?
3. In tables and procedures you mention endoscopic and surgical suturing. What exactly is the
difference? It is not clear in methods. Surgical suturing is the ligation device? These are both
endoscopic techniques from my point of view.
4. In the definitions you do not mention gastric wall damage. How did you evaluate gastric wall
damage? Do you mean damage to gastric mucosa propria?
5. Divide your results into two subsections. The first one should be named: “Perioperative patient
characteristics and histology of gastric submucosal tumors”. The second one: “Perioperative
patient characteristics and histology of GISTs”
6. In the beginning of the results and in the two tables, mention what your two groups are, and
the number of patients in each group.
7. How it is possible to have only 0.46 cm gastric wall damage in group B and you remove
from this defect a lesion of mean 1.95 cm? Unless you mean the damage in the gastric musoca
propria. You should clarify this.
8. In the results, rephrase the comparison between group A and B for the maximum pathological
size. How can it be greater when it is 1.26 vs 1.95? unless it is the opposite
9. In the beginning of the discussion, add a small paragraph, where you mention the findings
of your study.
10. "When excising muscularis propria tumors, novice doctors often experience a greater
psychological burden when a perforation occurs.  The proposed method is more suitable for
such doctors in excising muscularis propria tumors under endoscopic surgery because of the
increased safety following retraction of the knife tip. "
Is this based on personal experience or can you cite a reference for this conclusion?
11. Based on the two tables R1 resection occurred only in patients treated for GISTs. How did
these patients not have a recurrence? Did they take perhaps imatinib after the histology?
Overall it is a well-written manuscript in terms of clarity, language and methods enabling
reproducibility. There are only some points that need to be clarified. Thank you again.
assistant