Reviewer ’s report  
 
Title: Novel modified endoscopic mucosal resection of la rge GI lesions (>20mm) using an 
external additional working channel (AWC) may improve R0 r esection rate: Initial clinical 
experience  
 
Version: 0 Date: 09 Mar 2020  
 
Reviewer: Yi Bai  
 
Reviewer's report:  
 
This manuscript is very practical and innovative. The novel modified endoscopic using the AWC 
allows a second endoscopic device to be used while using another standard endoscopic 
equipment. The EMR+ tech nique provides an additional option to remove complex, large 
mucosal -based lesions in the GI tract, and maybe improve the efficacy of resection for lesions ≥ 
2cm and optimize R0 resection rates of lesions. However, some problems remain in this paper 
and th ey are described below:  
 
1. As a novel technique, we are interested in the comparison between it and current 
techniques. We will be appreciated if the authors describe the advantages and disadvantages of 
EMR+ and classical endoscopic techniques.  
 
2. Gross in spection is not potent enough to determine whether the en -bloc resection is 
achieved and therefore the pathological result of the incision edge is needed.  
 
3. More samples are needed to validate the feasibility and practicability of this novel 
technique.  
 
4. The inclusion criteria and exclusion criteria of patients should be described in more 
detail.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscr ipt: 
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, fees, fund ing, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, w rite 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be include d 
on my report to the authors and, if the manuscript is accepted f or pub lication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open A ccess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Novel modified endoscopic mucosal resection of la rge GI lesions (>20mm) using an 
external additional working channel (AWC) may improve R0 r esection rate: Initial clinical 
experience  
 
Version: 0 Date: 09 Mar 2020  
 
Reviewer: Yi Bai  
 
Reviewer's report:  
 
This manuscript is very practical and innovative. The novel modified endoscopic using the AWC 
allows a second endoscopic device to be used while using another standard endoscopic 
equipment. The EMR+ tech nique provides an additional option to remove complex, large 
mucosal -based lesions in the GI tract, and maybe improve the efficacy of resection for lesions ≥ 
2cm and optimize R0 resection rates of lesions. However, some problems remain in this paper 
and th ey are described below:  
 
1. As a novel technique, we are interested in the comparison between it and current 
techniques. We will be appreciated if the authors describe the advantages and disadvantages of 
EMR+ and classical endoscopic techniques.  
 
2. Gross in spection is not potent enough to determine whether the en -bloc resection is 
achieved and therefore the pathological result of the incision edge is needed.  
 
3. More samples are needed to validate the feasibility and practicability of this novel 
technique.  
 
4. The inclusion criteria and exclusion criteria of patients should be described in more 
detail.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscr ipt: 
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, fees, fund ing, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, w rite 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be include d 
on my report to the authors and, if the manuscript is accepted f or pub lication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open A ccess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Novel modified endoscopic mucosal resection of la rge GI lesions (>20mm) using an 
external additional working channel (AWC) may improve R0 r esection rate: Initial clinical 
experience  
 
Version: 0 Date: 09 Mar 2020  
 
Reviewer: Yi Bai  
 
Reviewer's report:  
 
This manuscript is very practical and innovative. The novel modified endoscopic using the AWC 
allows a second endoscopic device to be used while using another standard endoscopic 
equipment. The EMR+ tech nique provides an additional option to remove complex, large 
mucosal -based lesions in the GI tract, and maybe improve the efficacy of resection for lesions ≥ 
2cm and optimize R0 resection rates of lesions. However, some problems remain in this paper 
and th ey are described below:  
 
1. As a novel technique, we are interested in the comparison between it and current 
techniques. We will be appreciated if the authors describe the advantages and disadvantages of 
EMR+ and classical endoscopic techniques.  
 
2. Gross in spection is not potent enough to determine whether the en -bloc resection is 
achieved and therefore the pathological result of the incision edge is needed.  
 
3. More samples are needed to validate the feasibility and practicability of this novel 
technique.  
 
4. The inclusion criteria and exclusion criteria of patients should be described in more 
detail.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscr ipt: 
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, fees, fund ing, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, w rite 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be include d 
on my report to the authors and, if the manuscript is accepted f or pub lication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open A ccess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant