Title: Ligation-assisted endoscopic mucosal resection has high complete resection rate in rectal
carcinoid tumor
Version: 2 Date: 15 Sep 2021
Reviewer's report:
Major Revisions:
1. EMR details not presented;
Was en bloc resection performed? What snare type i.e braided vs serrated were used? What size
snares were used 10 vs 15mm or greater used?
2. What was the training level of endoscopists performing the procedures? Ie advanced
endoscopy experience. Especially given in the prospective arm rate of complete resection for
EMR is only 42% vs band ligation, which with standard EMR techniques should not be the case,
given the ability to treat advanced adenomas with en bloc resection.
3. Statistical methods:
a. No details on sample size calculations and expected rates of recurrence in treatment arm are
provided. This is important to understand why authors chose the treatment for a limited no. of
patients
b. Randomization – how were patient randomized? Was there blinding vs treatment allocation?
4. Of 145 patients assessed; how did the authors differentiate patients treated by EMR vs snare
polypectomy. As per current ESGE guidelines given most tumours were <10mm in size (mean
size = 6.5mm) conventional hot snare polypectomy is a suitable alternative to EMR.
5. So how many were cold snare vs hot snare. The outcomes of these modalities of snare
polypectomy should be reported separately
6. There is no information of the complete endoscopic resection rate, specifically for EMR.
Again, as per previous outcomes should be separated for hot vs cold snare polypectomy
7. The authors have not provided any pathology details on the carcinoid tumours ie
differentiation vs ki67 profile. Therefore, the clinical relevance of the study should be argued
as those low risk are unlikely to recur and affect a patient’s long-term prognosis especially for
lesions <5mm.
8. I think a key point in the discussion the authors have not raised is the use of ESD. That would
be a clearly better technique for lesions >10mm (i.e lesion too large for cap or band ligator).
This needs to be discussed and of course balanced with the limitations of advanced technique/
learning curve.
Minor revisions:
Multiple typing error eg. last line in methods “stdy” should be “study” or second last paragraph
in discussion “analusis” should be “analysis”
Title: Ligation-assisted endoscopic mucosal resection has high complete resection rate in rectal
carcinoid tumor
Version: 2 Date: 15 Sep 2021
Reviewer's report:
Major Revisions:
1. EMR details not presented;
Was en bloc resection performed? What snare type i.e braided vs serrated were used? What size
snares were used 10 vs 15mm or greater used?
2. What was the training level of endoscopists performing the procedures? Ie advanced
endoscopy experience. Especially given in the prospective arm rate of complete resection for
EMR is only 42% vs band ligation, which with standard EMR techniques should not be the case,
given the ability to treat advanced adenomas with en bloc resection.
3. Statistical methods:
a. No details on sample size calculations and expected rates of recurrence in treatment arm are
provided. This is important to understand why authors chose the treatment for a limited no. of
patients
b. Randomization – how were patient randomized? Was there blinding vs treatment allocation?
4. Of 145 patients assessed; how did the authors differentiate patients treated by EMR vs snare
polypectomy. As per current ESGE guidelines given most tumours were <10mm in size (mean
size = 6.5mm) conventional hot snare polypectomy is a suitable alternative to EMR.
5. So how many were cold snare vs hot snare. The outcomes of these modalities of snare
polypectomy should be reported separately
6. There is no information of the complete endoscopic resection rate, specifically for EMR.
Again, as per previous outcomes should be separated for hot vs cold snare polypectomy
7. The authors have not provided any pathology details on the carcinoid tumours ie
differentiation vs ki67 profile. Therefore, the clinical relevance of the study should be argued
as those low risk are unlikely to recur and affect a patient’s long-term prognosis especially for
lesions <5mm.
8. I think a key point in the discussion the authors have not raised is the use of ESD. That would
be a clearly better technique for lesions >10mm (i.e lesion too large for cap or band ligator).
This needs to be discussed and of course balanced with the limitations of advanced technique/
learning curve.
Minor revisions:
Multiple typing error eg. last line in methods “stdy” should be “study” or second last paragraph
in discussion “analusis” should be “analysis”
Please review this paper.
user
Title: Ligation-assisted endoscopic mucosal resection has high complete resection rate in rectal
carcinoid tumor
Version: 2 Date: 15 Sep 2021
Reviewer's report:
Major Revisions:
1. EMR details not presented;
Was en bloc resection performed? What snare type i.e braided vs serrated were used? What size
snares were used 10 vs 15mm or greater used?
2. What was the training level of endoscopists performing the procedures? Ie advanced
endoscopy experience. Especially given in the prospective arm rate of complete resection for
EMR is only 42% vs band ligation, which with standard EMR techniques should not be the case,
given the ability to treat advanced adenomas with en bloc resection.
3. Statistical methods:
a. No details on sample size calculations and expected rates of recurrence in treatment arm are
provided. This is important to understand why authors chose the treatment for a limited no. of
patients
b. Randomization – how were patient randomized? Was there blinding vs treatment allocation?
4. Of 145 patients assessed; how did the authors differentiate patients treated by EMR vs snare
polypectomy. As per current ESGE guidelines given most tumours were <10mm in size (mean
size = 6.5mm) conventional hot snare polypectomy is a suitable alternative to EMR.
5. So how many were cold snare vs hot snare. The outcomes of these modalities of snare
polypectomy should be reported separately
6. There is no information of the complete endoscopic resection rate, specifically for EMR.
Again, as per previous outcomes should be separated for hot vs cold snare polypectomy
7. The authors have not provided any pathology details on the carcinoid tumours ie
differentiation vs ki67 profile. Therefore, the clinical relevance of the study should be argued
as those low risk are unlikely to recur and affect a patient’s long-term prognosis especially for
lesions <5mm.
8. I think a key point in the discussion the authors have not raised is the use of ESD. That would
be a clearly better technique for lesions >10mm (i.e lesion too large for cap or band ligator).
This needs to be discussed and of course balanced with the limitations of advanced technique/
learning curve.
Minor revisions:
Multiple typing error eg. last line in methods “stdy” should be “study” or second last paragraph
in discussion “analusis” should be “analysis”
assistant