Reviewer ’s report  
 
Title: Clinical outcomes of over -the-scope -clip system for the treatment of acute upper non -
variceal gastrointestinal bleeding: a systematic review and meta -analysis  
 
Version: 0 Date: 28 Aug 2019  
 
Reviewer: Hsiu -Chi Cheng  
 
Reviewer's report:  
 
Review on BMGE -D-19-00591 by Zhong C, et al., entitled "Clinical outcomes of over -the-
scope -clip system for the treatment of acute upper nonvariceal gastrointestinal bleeding: a 
systematic review and meta -analysis"  
 
This study reviewed the feasibility, eff icacy, and complications of OTSC system for 
management of acute non -variceal upper GI bleeding. The following comments are for the 
reference of authors:  
 
Major comments  
1. Please provide an explicit statement regarding participants, interventions, compari sons, 
and outcomes (PICO) for this topic.  
2. Did this manuscript have systematic review registration number?  
3. Please provide search strategy. Whether did the authors use MeSH terms and All Fields 
to search gastrointestinal bleeding and OTSC? Whether di d the authors use "gastrointestinal 
hemorrhage," "hematemesis," "melena," or "peptic ulcer hemorrhage" to search the relevant 
studies?  
4. Whether were "OTSC" and "over the scope clip" enough to search the relevant studies?  
5. Figure 2 showed the proportion of acute upper non -variceal gastrointestinal bleeding 
etiologies. The etiologies are various. The risks of recurrent bleeding are different between these 
etiologies. For the concern of risk of bias, whether was the population  that was intended to be 
sampled representative?  
6. Regarding "Criteria for inclusion and exclusion" (Page 4), the authors reported that 
"Re-bleeding was diagnosed if a retreatment of the target lesion was required after initial 
successful endoscopic trea tment." It is different from what we know about the definition of re -
bleeding. In fact, clinical re -bleeding is diagnosed if persistent tarry stool passage with 
tachycardia, shock, or the hemoglobin level drop. Please explain why the authors made the 
defin ition.  
 
 
 
 
 
 
 
 
Are the methods appropriate and w ell described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusion s drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation that 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 recei ved 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, write '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 r eview policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, 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 Access 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 included a s 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: Clinical outcomes of over -the-scope -clip system for the treatment of acute upper non -
variceal gastrointestinal bleeding: a systematic review and meta -analysis  
 
Version: 0 Date: 28 Aug 2019  
 
Reviewer: Hsiu -Chi Cheng  
 
Reviewer's report:  
 
Review on BMGE -D-19-00591 by Zhong C, et al., entitled "Clinical outcomes of over -the-
scope -clip system for the treatment of acute upper nonvariceal gastrointestinal bleeding: a 
systematic review and meta -analysis"  
 
This study reviewed the feasibility, eff icacy, and complications of OTSC system for 
management of acute non -variceal upper GI bleeding. The following comments are for the 
reference of authors:  
 
Major comments  
1. Please provide an explicit statement regarding participants, interventions, compari sons, 
and outcomes (PICO) for this topic.  
2. Did this manuscript have systematic review registration number?  
3. Please provide search strategy. Whether did the authors use MeSH terms and All Fields 
to search gastrointestinal bleeding and OTSC? Whether di d the authors use "gastrointestinal 
hemorrhage," "hematemesis," "melena," or "peptic ulcer hemorrhage" to search the relevant 
studies?  
4. Whether were "OTSC" and "over the scope clip" enough to search the relevant studies?  
5. Figure 2 showed the proportion of acute upper non -variceal gastrointestinal bleeding 
etiologies. The etiologies are various. The risks of recurrent bleeding are different between these 
etiologies. For the concern of risk of bias, whether was the population  that was intended to be 
sampled representative?  
6. Regarding "Criteria for inclusion and exclusion" (Page 4), the authors reported that 
"Re-bleeding was diagnosed if a retreatment of the target lesion was required after initial 
successful endoscopic trea tment." It is different from what we know about the definition of re -
bleeding. In fact, clinical re -bleeding is diagnosed if persistent tarry stool passage with 
tachycardia, shock, or the hemoglobin level drop. Please explain why the authors made the 
defin ition.  
 
 
 
 
 
 
 
 
Are the methods appropriate and w ell described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusion s drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation that 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 recei ved 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, write '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 r eview policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, 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 Access 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 included a s 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: Clinical outcomes of over -the-scope -clip system for the treatment of acute upper non -
variceal gastrointestinal bleeding: a systematic review and meta -analysis  
 
Version: 0 Date: 28 Aug 2019  
 
Reviewer: Hsiu -Chi Cheng  
 
Reviewer's report:  
 
Review on BMGE -D-19-00591 by Zhong C, et al., entitled "Clinical outcomes of over -the-
scope -clip system for the treatment of acute upper nonvariceal gastrointestinal bleeding: a 
systematic review and meta -analysis"  
 
This study reviewed the feasibility, eff icacy, and complications of OTSC system for 
management of acute non -variceal upper GI bleeding. The following comments are for the 
reference of authors:  
 
Major comments  
1. Please provide an explicit statement regarding participants, interventions, compari sons, 
and outcomes (PICO) for this topic.  
2. Did this manuscript have systematic review registration number?  
3. Please provide search strategy. Whether did the authors use MeSH terms and All Fields 
to search gastrointestinal bleeding and OTSC? Whether di d the authors use "gastrointestinal 
hemorrhage," "hematemesis," "melena," or "peptic ulcer hemorrhage" to search the relevant 
studies?  
4. Whether were "OTSC" and "over the scope clip" enough to search the relevant studies?  
5. Figure 2 showed the proportion of acute upper non -variceal gastrointestinal bleeding 
etiologies. The etiologies are various. The risks of recurrent bleeding are different between these 
etiologies. For the concern of risk of bias, whether was the population  that was intended to be 
sampled representative?  
6. Regarding "Criteria for inclusion and exclusion" (Page 4), the authors reported that 
"Re-bleeding was diagnosed if a retreatment of the target lesion was required after initial 
successful endoscopic trea tment." It is different from what we know about the definition of re -
bleeding. In fact, clinical re -bleeding is diagnosed if persistent tarry stool passage with 
tachycardia, shock, or the hemoglobin level drop. Please explain why the authors made the 
defin ition.  
 
 
 
 
 
 
 
 
Are the methods appropriate and w ell described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusion s drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation that 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 recei ved 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, write '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 r eview policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, 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 Access 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 included a s confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant