Review for 10.1186/s12876-021-02085-w (2022)

Reviewer’s report
Title: 
Multi-loop traction device facilitates gastric endoscopic submucosal
dissection: ex vivo pilot study and an inaugural clinical experience
Version: 
1 
Date: 
31 Oct 2021
Reviewer's report:
The authors addressed the comments. However, the MLTD-assisted ESD had
two serious technical limitations. 
1. First, the scope access was limited to forward view, and the ESD was not
performed in the retroflexed view in this study. In real clinical practice, the
retroflexed scope position is more reasonably accessible and stable than the
forward position in gastric ESD of the lesser curvature side, which was not
evaluated in this study. A possible concern was that this limited scope approach
could make the procedure time of C-ESD longer. 
2. Second, limited air insufflation can cause poor visualization of a submucosal
plane and bleeding source, particularly in the greater curvature side, which was
not also evaluated in this study. 
I want the authors to accumulate more experience of MLTD-assisted ESD in
various situations and add more clinical data. 
Please explain how to overcome the limitations. This suggestion is essential to
conduct a prospective comparative clinical trial to demonstrate the utility of the
MLTD which the authors mentioned before the conclusions. 
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
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Yes
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from apparent manipulation?
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