Title: Diagnostic accuracy and influencing factors of microprobe endoscopic ultrasound for
gastrointestinal subepithelial lesions: a multicenter retrospective study
Version: 0 Date: 01 Mar 2025
Reviewer:  Ryosuke Sato
Reviewer's report:
Thank you for allowing me to review this manuscript. This study describes the usefulness of
microprobe endoscopic ultrasonography (MEUS) in differentiating subepithelial lesions (SELs),
and it is crucial for primary hospitals. The following are my comments for this manuscript.
Introduction:
The accuracy of EUS-FNA/B for SEL is stated as 59.9% (54.8% - 64.7%), but the cited literature
is a little old, and according to several recent meta-analyses (doi: 10.1016/j.gie.2024.02.003.
and doi: 10.1055/a-2156-0063.), the results are thought to be better.
Patient selection:
What is the reason for resecting tumors that are thought to not usually require resection, such as
leiomyomas and EPs? In particular, it seems that leiomyomas are being resected even though
about half of them are diagnosed as leiomyomas using MEUS.
MEUS process:
There is no detailed description of the differential diagnosis of SEL using MEUS (GIST,
leiomyoma, etc.). The authors should describe how they considered the diagnosis based on the
MEUS findings.
RESULTS:
In the case of GIST, there are also cases where it occurs in multiple locations, such as in
neurofibromatosis type 1, but it is also desirable to include information on family history and
hereditary diseases if possible.
RESULTS:
In the case of leiomyomas, 122 cases less than 2.0 cm in size (92.42%) were resected. If the
size is 2.0 cm or more, I think it is necessary to consider the possibility of GIST and resect it,
but I think that there is little significance in resecting leiomyomas that are less than 2.0 cm. For
differentiating between GIST and leiomyomas in SELs that are less than 2.0 cm, hyperechogenic
spots, hypoechoic halos, and cystic changes are thought to be useful, but are these findings also
commonly seen in GIST that is less than 2.0 cm?
Title: Diagnostic accuracy and influencing factors of microprobe endoscopic ultrasound for
gastrointestinal subepithelial lesions: a multicenter retrospective study
Version: 0 Date: 01 Mar 2025
Reviewer:  Ryosuke Sato
Reviewer's report:
Thank you for allowing me to review this manuscript. This study describes the usefulness of
microprobe endoscopic ultrasonography (MEUS) in differentiating subepithelial lesions (SELs),
and it is crucial for primary hospitals. The following are my comments for this manuscript.
Introduction:
The accuracy of EUS-FNA/B for SEL is stated as 59.9% (54.8% - 64.7%), but the cited literature
is a little old, and according to several recent meta-analyses (doi: 10.1016/j.gie.2024.02.003.
and doi: 10.1055/a-2156-0063.), the results are thought to be better.
Patient selection:
What is the reason for resecting tumors that are thought to not usually require resection, such as
leiomyomas and EPs? In particular, it seems that leiomyomas are being resected even though
about half of them are diagnosed as leiomyomas using MEUS.
MEUS process:
There is no detailed description of the differential diagnosis of SEL using MEUS (GIST,
leiomyoma, etc.). The authors should describe how they considered the diagnosis based on the
MEUS findings.
RESULTS:
In the case of GIST, there are also cases where it occurs in multiple locations, such as in
neurofibromatosis type 1, but it is also desirable to include information on family history and
hereditary diseases if possible.
RESULTS:
In the case of leiomyomas, 122 cases less than 2.0 cm in size (92.42%) were resected. If the
size is 2.0 cm or more, I think it is necessary to consider the possibility of GIST and resect it,
but I think that there is little significance in resecting leiomyomas that are less than 2.0 cm. For
differentiating between GIST and leiomyomas in SELs that are less than 2.0 cm, hyperechogenic
spots, hypoechoic halos, and cystic changes are thought to be useful, but are these findings also
commonly seen in GIST that is less than 2.0 cm?
Please review this paper.
user
Title: Diagnostic accuracy and influencing factors of microprobe endoscopic ultrasound for
gastrointestinal subepithelial lesions: a multicenter retrospective study
Version: 0 Date: 01 Mar 2025
Reviewer:  Ryosuke Sato
Reviewer's report:
Thank you for allowing me to review this manuscript. This study describes the usefulness of
microprobe endoscopic ultrasonography (MEUS) in differentiating subepithelial lesions (SELs),
and it is crucial for primary hospitals. The following are my comments for this manuscript.
Introduction:
The accuracy of EUS-FNA/B for SEL is stated as 59.9% (54.8% - 64.7%), but the cited literature
is a little old, and according to several recent meta-analyses (doi: 10.1016/j.gie.2024.02.003.
and doi: 10.1055/a-2156-0063.), the results are thought to be better.
Patient selection:
What is the reason for resecting tumors that are thought to not usually require resection, such as
leiomyomas and EPs? In particular, it seems that leiomyomas are being resected even though
about half of them are diagnosed as leiomyomas using MEUS.
MEUS process:
There is no detailed description of the differential diagnosis of SEL using MEUS (GIST,
leiomyoma, etc.). The authors should describe how they considered the diagnosis based on the
MEUS findings.
RESULTS:
In the case of GIST, there are also cases where it occurs in multiple locations, such as in
neurofibromatosis type 1, but it is also desirable to include information on family history and
hereditary diseases if possible.
RESULTS:
In the case of leiomyomas, 122 cases less than 2.0 cm in size (92.42%) were resected. If the
size is 2.0 cm or more, I think it is necessary to consider the possibility of GIST and resect it,
but I think that there is little significance in resecting leiomyomas that are less than 2.0 cm. For
differentiating between GIST and leiomyomas in SELs that are less than 2.0 cm, hyperechogenic
spots, hypoechoic halos, and cystic changes are thought to be useful, but are these findings also
commonly seen in GIST that is less than 2.0 cm?
assistant