Title: Simultaneous detection of Helicobacter pylori infection comparing between white light
and image-enhanced endoscopy
Version: 1 Date: 17 Oct 2023
Reviewer:  Masao Kobayakawa
Reviewer's report:
Comments to the authors
Major
Comparison of the sensitivities should be tested by McNemar test with Yates' continuity
correction, neither by Fishier nor Chi-square test because they are paired data. All comparisons
should be appropriately analyzed.
In the statistical analysis subsection, “the good clinical practice guideline” should be deleted
because probably this study was  not conducted in accordance with ICH-GCP guideline (https://
www.pmda.go.jp/files/000156725.pdf).
Did you prespecified where and how to take the pictures of gastric mucosa on WLI and LCI or
pit pattern on BLI and NBI, respectively?  Did the endoscopists took pictures their own way?
Were there any rules or standards?
You need to clarify whether you evaluated the preserved pictures after endoscopic procedure.
How many pictures were evaluated for each patient? All pictures the endoscopist took (in that
case, clarify mean or range), or prespecified number of the prespecified site?
You need to describe whether the three experts were blinded to H. pylori infection status when
they evaluated the gastric mucosa for this study.
The subsection of “Comparison of studies using IEE or WLI for diagnosis of H. pylori infection”
should be discussed in the Discussion section not in the Result section.
In the Discussion, line 221 to 225, your assertion could not be easily acceptable. Diffuse redness
and spotty redness are seen in the corpus where fundic glands exist.  Antrum predominant
gastritis (younger stomach) shows low activity in the corpus. If older patients influence the low
percentage of these findings, you should explain it with your data itself.
Minor
This study is prospective study with obtained informed consent. You should describe you
obtained informed consent from each patient prior to the enrollment and all study procedures in
the “Study design” subsection not in the “Statistical analysis” subsection.
In the “Endoscopic diagnosis of H. pylori infection” subsection, your description is like a
review of previous studies, which should be briefly explained in the introduction or discussed
in the Discussion section. Instead, you should clarify the data you collected in this study (e.g.,
the presence or absence of following findings were assessed: mucosal edema,………, and
hyperplastic poly by WLI and LCI. ). You should clarify the definitions you used in the study
(e.g., the presence or absence of enlarged or elongated pits with obscure SECN and dense fine
irregular vessels by NBI and BLI were assessed and H. pylori infection was positive if at least
one of these findings was present by NBI and BLI, respectively.).
A total of 4 biopsy specimens (Line 152) were sent for rapid urease test, histopathology, and
culture. How were the 4 specimens divided to each H. pylori test? Did all 3 different tests were
performed in each patient? The number of biopsies is different from the Abstract (antrum and
2 at body).
Table 1 should include endoscopic clinical diagnosis of the stomach such as gastric ulcer,
duodenal ulcer, atrophic gastritis, or gastric cancer etc.
Table 3 should include the diagnostic performance of hyperplastic polyp which was in the H.
pylori positive findings defined by the authors.
You define the H. pylori infection by WLI and LCI as presence of at least one of 7 H. pylori
indicative findings. You should show the sensitivity and specificity for H. pylori infection by
WLI based on the above definition in Table 2 and/or 3 so that it can be comparable with LCI
and so on.
In the Discussion, lines 218 to 219, the precise data should be described in the Result section.
In the Discussion, lines 243-245, these data should also be described in the Result section.
Title: Simultaneous detection of Helicobacter pylori infection comparing between white light
and image-enhanced endoscopy
Version: 1 Date: 17 Oct 2023
Reviewer:  Masao Kobayakawa
Reviewer's report:
Comments to the authors
Major
Comparison of the sensitivities should be tested by McNemar test with Yates' continuity
correction, neither by Fishier nor Chi-square test because they are paired data. All comparisons
should be appropriately analyzed.
In the statistical analysis subsection, “the good clinical practice guideline” should be deleted
because probably this study was  not conducted in accordance with ICH-GCP guideline (https://
www.pmda.go.jp/files/000156725.pdf).
Did you prespecified where and how to take the pictures of gastric mucosa on WLI and LCI or
pit pattern on BLI and NBI, respectively?  Did the endoscopists took pictures their own way?
Were there any rules or standards?
You need to clarify whether you evaluated the preserved pictures after endoscopic procedure.
How many pictures were evaluated for each patient? All pictures the endoscopist took (in that
case, clarify mean or range), or prespecified number of the prespecified site?
You need to describe whether the three experts were blinded to H. pylori infection status when
they evaluated the gastric mucosa for this study.
The subsection of “Comparison of studies using IEE or WLI for diagnosis of H. pylori infection”
should be discussed in the Discussion section not in the Result section.
In the Discussion, line 221 to 225, your assertion could not be easily acceptable. Diffuse redness
and spotty redness are seen in the corpus where fundic glands exist.  Antrum predominant
gastritis (younger stomach) shows low activity in the corpus. If older patients influence the low
percentage of these findings, you should explain it with your data itself.
Minor
This study is prospective study with obtained informed consent. You should describe you
obtained informed consent from each patient prior to the enrollment and all study procedures in
the “Study design” subsection not in the “Statistical analysis” subsection.
In the “Endoscopic diagnosis of H. pylori infection” subsection, your description is like a
review of previous studies, which should be briefly explained in the introduction or discussed
in the Discussion section. Instead, you should clarify the data you collected in this study (e.g.,
the presence or absence of following findings were assessed: mucosal edema,………, and
hyperplastic poly by WLI and LCI. ). You should clarify the definitions you used in the study
(e.g., the presence or absence of enlarged or elongated pits with obscure SECN and dense fine
irregular vessels by NBI and BLI were assessed and H. pylori infection was positive if at least
one of these findings was present by NBI and BLI, respectively.).
A total of 4 biopsy specimens (Line 152) were sent for rapid urease test, histopathology, and
culture. How were the 4 specimens divided to each H. pylori test? Did all 3 different tests were
performed in each patient? The number of biopsies is different from the Abstract (antrum and
2 at body).
Table 1 should include endoscopic clinical diagnosis of the stomach such as gastric ulcer,
duodenal ulcer, atrophic gastritis, or gastric cancer etc.
Table 3 should include the diagnostic performance of hyperplastic polyp which was in the H.
pylori positive findings defined by the authors.
You define the H. pylori infection by WLI and LCI as presence of at least one of 7 H. pylori
indicative findings. You should show the sensitivity and specificity for H. pylori infection by
WLI based on the above definition in Table 2 and/or 3 so that it can be comparable with LCI
and so on.
In the Discussion, lines 218 to 219, the precise data should be described in the Result section.
In the Discussion, lines 243-245, these data should also be described in the Result section.
Please review this paper.
user
Title: Simultaneous detection of Helicobacter pylori infection comparing between white light
and image-enhanced endoscopy
Version: 1 Date: 17 Oct 2023
Reviewer:  Masao Kobayakawa
Reviewer's report:
Comments to the authors
Major
Comparison of the sensitivities should be tested by McNemar test with Yates' continuity
correction, neither by Fishier nor Chi-square test because they are paired data. All comparisons
should be appropriately analyzed.
In the statistical analysis subsection, “the good clinical practice guideline” should be deleted
because probably this study was  not conducted in accordance with ICH-GCP guideline (https://
www.pmda.go.jp/files/000156725.pdf).
Did you prespecified where and how to take the pictures of gastric mucosa on WLI and LCI or
pit pattern on BLI and NBI, respectively?  Did the endoscopists took pictures their own way?
Were there any rules or standards?
You need to clarify whether you evaluated the preserved pictures after endoscopic procedure.
How many pictures were evaluated for each patient? All pictures the endoscopist took (in that
case, clarify mean or range), or prespecified number of the prespecified site?
You need to describe whether the three experts were blinded to H. pylori infection status when
they evaluated the gastric mucosa for this study.
The subsection of “Comparison of studies using IEE or WLI for diagnosis of H. pylori infection”
should be discussed in the Discussion section not in the Result section.
In the Discussion, line 221 to 225, your assertion could not be easily acceptable. Diffuse redness
and spotty redness are seen in the corpus where fundic glands exist.  Antrum predominant
gastritis (younger stomach) shows low activity in the corpus. If older patients influence the low
percentage of these findings, you should explain it with your data itself.
Minor
This study is prospective study with obtained informed consent. You should describe you
obtained informed consent from each patient prior to the enrollment and all study procedures in
the “Study design” subsection not in the “Statistical analysis” subsection.
In the “Endoscopic diagnosis of H. pylori infection” subsection, your description is like a
review of previous studies, which should be briefly explained in the introduction or discussed
in the Discussion section. Instead, you should clarify the data you collected in this study (e.g.,
the presence or absence of following findings were assessed: mucosal edema,………, and
hyperplastic poly by WLI and LCI. ). You should clarify the definitions you used in the study
(e.g., the presence or absence of enlarged or elongated pits with obscure SECN and dense fine
irregular vessels by NBI and BLI were assessed and H. pylori infection was positive if at least
one of these findings was present by NBI and BLI, respectively.).
A total of 4 biopsy specimens (Line 152) were sent for rapid urease test, histopathology, and
culture. How were the 4 specimens divided to each H. pylori test? Did all 3 different tests were
performed in each patient? The number of biopsies is different from the Abstract (antrum and
2 at body).
Table 1 should include endoscopic clinical diagnosis of the stomach such as gastric ulcer,
duodenal ulcer, atrophic gastritis, or gastric cancer etc.
Table 3 should include the diagnostic performance of hyperplastic polyp which was in the H.
pylori positive findings defined by the authors.
You define the H. pylori infection by WLI and LCI as presence of at least one of 7 H. pylori
indicative findings. You should show the sensitivity and specificity for H. pylori infection by
WLI based on the above definition in Table 2 and/or 3 so that it can be comparable with LCI
and so on.
In the Discussion, lines 218 to 219, the precise data should be described in the Result section.
In the Discussion, lines 243-245, these data should also be described in the Result section.
assistant