Reviewer's report
Title:Differences in Bleeding Behavior after Endoscopic Band Ligation: A
Retrospective Analysis
Version: 2Date:5 September 2009
Reviewer: Justin Cheung
Reviewer's report:
Major Compulsory Revisions
1) The reply by the authors for point 1 is not correct. Although the aim is to
evaluate bleeding risk associated with EBL procedures, it is not the “best way” to
analyze the data according to EBL procedures if patients can be included more
than once into the analysis. The best way would be for a single patient to be
entered after a single EBL procedure, and then excluded from re-entry into the
analysis if they undergo another EBL procedure. For example if you included a
patient with Child Pugh A multiple times, than one would think that rebleeding
results would be less than if you included a CP C patient multiple times.
If the authors can not exclude repeated patients from analysis, then they should
comment it as a limitation of the paper.
The paper should also comment on the major potential limitations in the study in
the discussion.
2) the AIM of the study (to evaluate the circumstances under which
hospitalization after EBL can be shortened) is not clear nor consistent with the
methodology of the study. The authors should indicate what the Primary
Outcome they are assessing in the AIMS of the study (ie mortality or bleeding
after after EBL). Additionally, if they are evaluating “circumstances” related to a
Primary Outcome, then many factors should be taken into account in the analysis
(ie do factors such as age, CP score, MELD, grade of varices, elective vs urgent
EBL). I don’t think they can say they evaluated “circumstances” since many
important factors were not analyzed/correlated with the outcome of interest
(Which usually requires a Regression Analysis). Did the authors intend to
compare the outcome of “Bleeding” among elective vs acute variceal bleeding?
3) Again I would be cautious about using the term “should” in the conclusion
based on a retrospective study. This is especially true since there many factors
potentially associated with bleeding risk were not evaluated. For example should
all acute variceal bleeds be really kept 11 days? What about those who had large
varices vs small varices, what about CP A vs CP B patients, what about those
with active bleeding at endoscopy vs no active bleeding, what about MELD score
status, what about cause of liver disease such as ongoing alcohol use? What
about those with a history or recurrent bleed vs no previous bleeding history?
Since there are so many unanswered important questions…a less definitive
statement should be used in the conclusion
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Differences in Bleeding Behavior after Endoscopic Band Ligation: A
Retrospective Analysis
Version: 2Date:5 September 2009
Reviewer: Justin Cheung
Reviewer's report:
Major Compulsory Revisions
1) The reply by the authors for point 1 is not correct. Although the aim is to
evaluate bleeding risk associated with EBL procedures, it is not the “best way” to
analyze the data according to EBL procedures if patients can be included more
than once into the analysis. The best way would be for a single patient to be
entered after a single EBL procedure, and then excluded from re-entry into the
analysis if they undergo another EBL procedure. For example if you included a
patient with Child Pugh A multiple times, than one would think that rebleeding
results would be less than if you included a CP C patient multiple times.
If the authors can not exclude repeated patients from analysis, then they should
comment it as a limitation of the paper.
The paper should also comment on the major potential limitations in the study in
the discussion.
2) the AIM of the study (to evaluate the circumstances under which
hospitalization after EBL can be shortened) is not clear nor consistent with the
methodology of the study. The authors should indicate what the Primary
Outcome they are assessing in the AIMS of the study (ie mortality or bleeding
after after EBL). Additionally, if they are evaluating “circumstances” related to a
Primary Outcome, then many factors should be taken into account in the analysis
(ie do factors such as age, CP score, MELD, grade of varices, elective vs urgent
EBL). I don’t think they can say they evaluated “circumstances” since many
important factors were not analyzed/correlated with the outcome of interest
(Which usually requires a Regression Analysis). Did the authors intend to
compare the outcome of “Bleeding” among elective vs acute variceal bleeding?
3) Again I would be cautious about using the term “should” in the conclusion
based on a retrospective study. This is especially true since there many factors
potentially associated with bleeding risk were not evaluated. For example should
all acute variceal bleeds be really kept 11 days? What about those who had large
varices vs small varices, what about CP A vs CP B patients, what about those
with active bleeding at endoscopy vs no active bleeding, what about MELD score
status, what about cause of liver disease such as ongoing alcohol use? What
about those with a history or recurrent bleed vs no previous bleeding history?
Since there are so many unanswered important questions…a less definitive
statement should be used in the conclusion
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Differences in Bleeding Behavior after Endoscopic Band Ligation: A
Retrospective Analysis
Version: 2Date:5 September 2009
Reviewer: Justin Cheung
Reviewer's report:
Major Compulsory Revisions
1) The reply by the authors for point 1 is not correct. Although the aim is to
evaluate bleeding risk associated with EBL procedures, it is not the “best way” to
analyze the data according to EBL procedures if patients can be included more
than once into the analysis. The best way would be for a single patient to be
entered after a single EBL procedure, and then excluded from re-entry into the
analysis if they undergo another EBL procedure. For example if you included a
patient with Child Pugh A multiple times, than one would think that rebleeding
results would be less than if you included a CP C patient multiple times.
If the authors can not exclude repeated patients from analysis, then they should
comment it as a limitation of the paper.
The paper should also comment on the major potential limitations in the study in
the discussion.
2) the AIM of the study (to evaluate the circumstances under which
hospitalization after EBL can be shortened) is not clear nor consistent with the
methodology of the study. The authors should indicate what the Primary
Outcome they are assessing in the AIMS of the study (ie mortality or bleeding
after after EBL). Additionally, if they are evaluating “circumstances” related to a
Primary Outcome, then many factors should be taken into account in the analysis
(ie do factors such as age, CP score, MELD, grade of varices, elective vs urgent
EBL). I don’t think they can say they evaluated “circumstances” since many
important factors were not analyzed/correlated with the outcome of interest
(Which usually requires a Regression Analysis). Did the authors intend to
compare the outcome of “Bleeding” among elective vs acute variceal bleeding?
3) Again I would be cautious about using the term “should” in the conclusion
based on a retrospective study. This is especially true since there many factors
potentially associated with bleeding risk were not evaluated. For example should
all acute variceal bleeds be really kept 11 days? What about those who had large
varices vs small varices, what about CP A vs CP B patients, what about those
with active bleeding at endoscopy vs no active bleeding, what about MELD score
status, what about cause of liver disease such as ongoing alcohol use? What
about those with a history or recurrent bleed vs no previous bleeding history?
Since there are so many unanswered important questions…a less definitive
statement should be used in the conclusion
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
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