Review for 10.1186/s12876-022-02202-3 (2022)

Reviewer’s report
Title: 
Prophylactic clip closure for mucosal defects is associated with reduced
adverse events after colorectal endoscopic submucosal dissection: a propensity-
score matching analysis
Version: 
0 
Date: 
27 Nov 2021
Reviewer's report:
The authors conducted a retrospective study with propensity-score matching
analysis to evaluate the efficacy of prophylactic clip closure in preventing
postoperative adverse events after colorectal ESD. There has been much debate
about this content, and this relatively small-sample study does not include highly
novel results. There are some comments below.
1. The authors should explain the disadvantages of prophylactic clip closure. The
cost of the clip, the treatment time, and the risk of damaging the muscle layer
due to the clip.
2. It should be clearly stated whether the antithrombotic drug is taken
continuously or withdrawn.
3. The reason for clip suturing is also important. That is, is it because the
resected ulcer could be easily closed by clips, or is it because of damage to the
muscular layer to avoid complications? 
Please discuss this point.
4. 
Lesions that can be easily closed by clips may be easy lesions for ESD. It is
also necessary to discuss whether it is necessary to perform clip closure even for
such lesions. The frequency of muscle layer damage, if any, should also be
stated.
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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?
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