Reviewer ’s report  
 
Title: FEASIBILITY OF USING AN LED -PROBE IN THIRD -SPACE ENDOSCOPY: A  
CLINICAL STUDY  
 
Version: 2 Date: 14 Feb 2020  
 
Reviewer: Radu Pescarus  
 
Reviewer's report:  
 
Thank you for the opportunity to review this novel approach to assessing adequacy of myotomies 
in POEM and G -POEM procedures with t he aid of a self made LED Probe (LP).  
 
As mentioned in your paper, the distal extent of the myotomy during a POEM or G -POEM case 
is sometimes difficult to assess. This has prompted previous authors to study the use the double -
scope technique (Baldaques -Silva S et al GiE 2014 &amp;  Grimes KL et al Surg Endo 2016), 
fluoroscopy (Kumbhari V GiE 2015), EndoFLIP (Rieder E et al Surg Endosc 2013), optical 
coherence tomography (Parra V VideoGiE 2015) or certain anatomical landmarks such as the 2 
penetrating vessel s (Tanaka S et al Dig Endosc 2018), besides the usual endoscopic cues. The 
authors of this paper present a novel probe that can be inserted in a 'blind' fashion into the 
submucosal tunnel and therefore avoid the associated costs of the double -scope techniq ue or 
fluoroscopy.  
 
Your paper raises a few important questions:  
 
1. What sterilization technique was employed for the LED probe ? What are your concerns about 
potential mediastinal infections or other bacterial contamination?  
2. Where there any challeng ing cases in which the blind insertion of the LED probe into the 
tunnel was difficult? Any mediastinal exposure due to the probe? Where the 2 bleeding cases in 
the POEM group or the capnoperitoneum cases in both POEM et G -POEM cases caused by the 
probe ins ertion? Was the mucosal opening bigger after the insertion of the probe? Any 
challenges with probe insertion in anterior vs posterior POEM. For the G -POEM a posterior 
approach was used ?  
3. Was there a systematic second look endoscopy in the submucosal tun nel after removal of the 
probe even in the cases where the myotomy was considered adequate?  
4. It was mentioned the POEM patients received antibiotics pre -intervention. Could you 
comment on antibiotic coverage and administration schedule. Same thing for t he G -POEM 
patients.  
5. Were the POEM procedures performed under general anesthesia?  
6. Do you think that performing the distal extension of the gastric myotomy may increase the 
success rate of the procedure (unlike the 3 year results post POEM of Grimes KL  et al Surg 
Endosc 2019)?  
7. Could you comment on your respective learning curve of these 2 procedures? Could it be that 
the perceived positive impact of the LED probe is greater early in the learning curve of a third -
space endoscopic procedure ?  
 
 
Are the method s appropriate and well 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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unab le to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additiona l statistical review is recommended, please specify 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 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 received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied f or 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 review 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 as confidential comments  
to the editors, which will not be published.  
 
I agree to the open pee r review policy of the journal  
Reviewer ’s report  
 
Title: FEASIBILITY OF USING AN LED -PROBE IN THIRD -SPACE ENDOSCOPY: A  
CLINICAL STUDY  
 
Version: 2 Date: 14 Feb 2020  
 
Reviewer: Radu Pescarus  
 
Reviewer's report:  
 
Thank you for the opportunity to review this novel approach to assessing adequacy of myotomies 
in POEM and G -POEM procedures with t he aid of a self made LED Probe (LP).  
 
As mentioned in your paper, the distal extent of the myotomy during a POEM or G -POEM case 
is sometimes difficult to assess. This has prompted previous authors to study the use the double -
scope technique (Baldaques -Silva S et al GiE 2014 &amp;  Grimes KL et al Surg Endo 2016), 
fluoroscopy (Kumbhari V GiE 2015), EndoFLIP (Rieder E et al Surg Endosc 2013), optical 
coherence tomography (Parra V VideoGiE 2015) or certain anatomical landmarks such as the 2 
penetrating vessel s (Tanaka S et al Dig Endosc 2018), besides the usual endoscopic cues. The 
authors of this paper present a novel probe that can be inserted in a 'blind' fashion into the 
submucosal tunnel and therefore avoid the associated costs of the double -scope techniq ue or 
fluoroscopy.  
 
Your paper raises a few important questions:  
 
1. What sterilization technique was employed for the LED probe ? What are your concerns about 
potential mediastinal infections or other bacterial contamination?  
2. Where there any challeng ing cases in which the blind insertion of the LED probe into the 
tunnel was difficult? Any mediastinal exposure due to the probe? Where the 2 bleeding cases in 
the POEM group or the capnoperitoneum cases in both POEM et G -POEM cases caused by the 
probe ins ertion? Was the mucosal opening bigger after the insertion of the probe? Any 
challenges with probe insertion in anterior vs posterior POEM. For the G -POEM a posterior 
approach was used ?  
3. Was there a systematic second look endoscopy in the submucosal tun nel after removal of the 
probe even in the cases where the myotomy was considered adequate?  
4. It was mentioned the POEM patients received antibiotics pre -intervention. Could you 
comment on antibiotic coverage and administration schedule. Same thing for t he G -POEM 
patients.  
5. Were the POEM procedures performed under general anesthesia?  
6. Do you think that performing the distal extension of the gastric myotomy may increase the 
success rate of the procedure (unlike the 3 year results post POEM of Grimes KL  et al Surg 
Endosc 2019)?  
7. Could you comment on your respective learning curve of these 2 procedures? Could it be that 
the perceived positive impact of the LED probe is greater early in the learning curve of a third -
space endoscopic procedure ?  
 
 
Are the method s appropriate and well 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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unab le to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additiona l statistical review is recommended, please specify 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 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 received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied f or 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 review 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 as confidential comments  
to the editors, which will not be published.  
 
I agree to the open pee r review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: FEASIBILITY OF USING AN LED -PROBE IN THIRD -SPACE ENDOSCOPY: A  
CLINICAL STUDY  
 
Version: 2 Date: 14 Feb 2020  
 
Reviewer: Radu Pescarus  
 
Reviewer's report:  
 
Thank you for the opportunity to review this novel approach to assessing adequacy of myotomies 
in POEM and G -POEM procedures with t he aid of a self made LED Probe (LP).  
 
As mentioned in your paper, the distal extent of the myotomy during a POEM or G -POEM case 
is sometimes difficult to assess. This has prompted previous authors to study the use the double -
scope technique (Baldaques -Silva S et al GiE 2014 &amp;  Grimes KL et al Surg Endo 2016), 
fluoroscopy (Kumbhari V GiE 2015), EndoFLIP (Rieder E et al Surg Endosc 2013), optical 
coherence tomography (Parra V VideoGiE 2015) or certain anatomical landmarks such as the 2 
penetrating vessel s (Tanaka S et al Dig Endosc 2018), besides the usual endoscopic cues. The 
authors of this paper present a novel probe that can be inserted in a 'blind' fashion into the 
submucosal tunnel and therefore avoid the associated costs of the double -scope techniq ue or 
fluoroscopy.  
 
Your paper raises a few important questions:  
 
1. What sterilization technique was employed for the LED probe ? What are your concerns about 
potential mediastinal infections or other bacterial contamination?  
2. Where there any challeng ing cases in which the blind insertion of the LED probe into the 
tunnel was difficult? Any mediastinal exposure due to the probe? Where the 2 bleeding cases in 
the POEM group or the capnoperitoneum cases in both POEM et G -POEM cases caused by the 
probe ins ertion? Was the mucosal opening bigger after the insertion of the probe? Any 
challenges with probe insertion in anterior vs posterior POEM. For the G -POEM a posterior 
approach was used ?  
3. Was there a systematic second look endoscopy in the submucosal tun nel after removal of the 
probe even in the cases where the myotomy was considered adequate?  
4. It was mentioned the POEM patients received antibiotics pre -intervention. Could you 
comment on antibiotic coverage and administration schedule. Same thing for t he G -POEM 
patients.  
5. Were the POEM procedures performed under general anesthesia?  
6. Do you think that performing the distal extension of the gastric myotomy may increase the 
success rate of the procedure (unlike the 3 year results post POEM of Grimes KL  et al Surg 
Endosc 2019)?  
7. Could you comment on your respective learning curve of these 2 procedures? Could it be that 
the perceived positive impact of the LED probe is greater early in the learning curve of a third -
space endoscopic procedure ?  
 
 
Are the method s appropriate and well 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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unab le to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additiona l statistical review is recommended, please specify 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 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 received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied f or 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 review 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 as confidential comments  
to the editors, which will not be published.  
 
I agree to the open pee r review policy of the journal  
assistant