JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-025-03883-2 (2025)

Title: Dynamic Variations in Peripheral Blood Indices and Their Association with Efficacy
and Adverse Reactions of PD-1 Inhibitor Combined Chemotherapy in Patients with Advanced
Gastric Cancer
Version: 6 Date: 12 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03883-2 (2025)

Title: Dynamic Variations in Peripheral Blood Indices and Their Association with Efficacy
and Adverse Reactions of PD-1 Inhibitor Combined Chemotherapy in Patients with Advanced
Gastric Cancer
Version: 6 Date: 27 Mar 2025
Reviewer's report:
Based on the revised version, the authors have made significant revisions that address most of
the major concerns raised previously. The key improvements are:
Improved transparency: The addition of the CONSORT flow diagram is excellent.
Toned-down conclusions: The authors are now appropriately cautious in their interpretations.
Better figure presentation: The Kaplan-Meier curves are significantly improved.
Strengthened discussion: The discussion is more thorough and critically engages with the
existing literature.
Complete ethics statement: The ethics statement is now comprehensive.
I recommend accepting the manuscript.
Review for 10.1186/s12876-024-03536-w (2025)

Title: Location of ERCP Impacts Fluoroscopy Time: A Multi-Institutional Retrospective Study
at Tertiary Academic Centers
Version: 1 Date: 02 Jun 2024
Reviewer's report:
This study is a report of a relatively large sample size for exposure to ERCP.
The theme of the difference of radiation exposure  whether fluoroscopic manipulation is
performed by an endoscopist or a radiology technician, and whether the fluoroscopy is
performed after hours or not.
#1. Fluoroscopic procedures such as ERCP vary greatly between diagnosis and treatment.
Especially in treatment,  the difficulty differ depending on the purpose of treatment, so it is
difficult to make comparisons without the background of such procedures. As mentioned in
the Limitation section of the Discussion, in urgent cases or out-of-hours situations, it is often
necessary to minimize the procedures to a minimum, such as drainage only.
It would be very interesting to see the results of the study that there was a difference in the results
of EU, RS, and OR, though, it is difficult to conclude from this results that there is a difference
in fluoroscopy time between endoscopists or technicians.
#2. The term "Multi-Institutional" is mentioned, but the breakdown of multi-institutional should
be indicated.
Method section line, only the setup of one institution is described.
"ERCPs in the EU were performed with Siemens Luminos Agile fluoroscopy device, in the RS
with Shimadzu G4 Sonial vision fluoroscopy device, and in the OR with GE OEC Elite C-Arm
device."
Review for 10.1186/s12876-024-03536-w (2025)

Title: Location of ERCP Impacts Fluoroscopy Time: A Multi-Institutional Retrospective Study
at Tertiary Academic Centers
Version: 1 Date: 20 Jun 2024
Reviewer's report:
The manuscript presents a well-conducted multi-institutional retrospective study examining the
impact of ERCP location on fluoroscopy time (FT). While the study lacks significant novelty
and originality, as the relationship between ERCP procedures and fluoroscopy time has been
explored in previous studies, it compensates with a robust dataset drawn from multiple tertiary
academic centers. The large sample size and the inclusion of diverse procedural settings provide
a valuable contribution to the existing literature.
Minor points
1. Based on the findings, the authors have a crucial role in proposing concrete strategies
for minimizing fluoroscopy time. These could include standardizing protocols, training and
education, technological improvements, and workflow optimization. By taking the lead in this,
the authors can significantly enhance the impact of their research.
2. The manuscript currently contains a limited number of references, which may not adequately
cover the breadth of existing research in this area. To strengthen the literature review and provide
a comprehensive background, the authors should consider including additional references.
Review for 10.1186/s12876-025-03717-1 (2025)

Title: Long Transparent Cap-Assisted Clip Closure Technique: A New Choice for
Gastrointestinal Defect Closure
Version: 2 Date: 01 Feb 2025
Reviewer's report:
This study evaluates the safety and effectiveness of the novel long transparent cap-assisted
clip closure technique (LTCCC) for closing gastrointestinal defects after endoscopic resection
(ER) of gastric submucosal tumors. Patients were divided into two groups: LTCCC and Purse-
String Suture (PSS). Both groups had a 100% closure success rate, but the closure time was
significantly shorter in the LTCCC group (17.44 minutes) compared to the PSS group (28.81
minutes). There were no significant differences between the two groups regarding postoperative
hospital stays or adverse events. During a median follow-up of 32 months, no complications
such as tumor recurrence, metastasis, or gastrointestinal fistulae were observed. The LTCCC
technique is considered a simple, safe, and effective option for closing gastrointestinal defects.
The authors mention other closure techniques like OTSC and OverStitch but do not provide
a thorough comparison in terms of safety, effectiveness, and clinical applicability. While they
state that these techniques are less commonly used in clinical practice in Asian countries, they
could provide more context as to why those techniques are not suitable for certain patients or
regions. A more detailed analysis of these alternatives would strengthen the argument for the
LTCCC technique as the preferred method.
The authors acknowledge that the LTCCC technique may offer a more secure closure than
the PSS method, but they also mention the theoretical risk of clip detachment under certain
conditions. This is an important point that could be expanded upon. How often do such risks
occur in practice? Can this potential issue be mitigated further with any modifications to the
technique? It would be helpful if the authors discussed how frequently this has been observed
in their cohort or referenced data from other studies to support or alleviate this concern.
The authors mention that less experienced physicians can become proficient with short-term
training, which is a positive aspect of the LTCCC technique. However, they do not discuss the
variability in the skill level of operators in their study. Given that the technique's success is
largely dependent on the physician's skills, further elaboration on how physician experience or
training might influence outcomes would be valuable. Were there any challenges or learning
curves observed in this study, and if so, how were they addressed?
Some sections of the discussion could be more concise. For example, the extended explanation
about the disadvantages of the PSS technique is somewhat repetitive and could be streamlined
for better clarity. A clearer focus on the main findings and their implications would improve the
readability of the discussion.
Review for 10.1186/s12876-025-03717-1 (2025)

Title: Long Transparent Cap-Assisted Clip Closure Technique: A New Choice for
Gastrointestinal Defect Closure
Version: 2 Date: 06 Feb 2025
Reviewer:  Takeshi Ohki
Reviewer's report:
(1) This paper compares the long transparent cap-assisted clip closure technique (LTCCC)
advocated by the authors with the conventional purse-string suture (PSS). As the authors
mention, the technique of closing with an endoscopic clip using a cap and suction has been a
standard procedure for some time, and fixing the tip of the cap in place or using a hard cap with
a nail are also techniques that have been used. The LTCCC technique that the authors advocate
is not a novel technique, as can be seen in Figure 1, but is just one of the arrangements.
(2) The background of LTCCC and PSS is different, and PSS is thought to be selected for larger
lesions and mucosal defects. Therefore, in order to perform accurate matching using propensity
score matching (PSM), it is necessary to include the size of the tumour or specimen, or the size
of the mucosal defect, in the evaluation.
(3) In order to convince readers, it would be preferable to compare the conventional method
using a cap with the authors' modifications with PSS, or to compare a simple endoscopic closure
technique that does not use a cap or PSS.
Review for 10.1186/s12876-025-03717-1 (2025)

Title: Long Transparent Cap-Assisted Clip Closure Technique: A New Choice for
Gastrointestinal Defect Closure
Version: 2 Date: 08 Feb 2025
Reviewer:  Teppei Masunaga
Reviewer's report:
Thank you for allowing me to review the manuscript. You mentioned new closure technique. It
is unique and interesting. However, there are several concerns which should be considered.
1. How is the closure outcome of the LTCCC group before propensity scores matching? Were
the any dehiscence of the defect cases or long hospital stay cases or severe adverse events?
Comparison is important, but you should also show the feasibility of this new closure method
without adjusting the sample size.
2, Theoretically, this closure method can close the defect only in cases where the length between
the both side of the wound is less than the diameter of the distal attachment. The defect of the
cases presented in the video and figure was small. What is the indication of this method? How
large a defect can be closed by this method?
3. In this method, can large clip (width >10mm) be used? What is your recommendation about
the type of the clips.
4, How long is the length between the distal edge of the endoscope and the distal edge of the
attachment ?
5. What are the covariates for propensity scores matching? You should mention it in the statistics
section.
6. You mentioned “the protruding clip often pushes the wound mucosa further away,” in the
discussion session. I cannot understand the meaning of this sentence. Please explain that more
understandably?
Review for 10.1186/s12876-025-03717-1 (2025)

Title: Long Transparent Cap-Assisted Clip Closure Technique: A New Choice for
Gastrointestinal Defect Closure
Version: 2 Date: 09 Feb 2025
Reviewer's report:
In the article, it is presented as a new technique for closing the wall defect after endoscopic
sumucosal dissection. However, it is seen that the newly presented techniques have been used
in the literature for the last 15 years. The remarkable situation in the study is the comparison
of the Cap-Assisted Clip Closure Technique, which is an easier and more affordable method
used in many centers, with the endoscopic Purse-String Suture technique, which requires skill
and is costly.
Review for 10.1186/s12876-025-03717-1 (2025)

Title: Long Transparent Cap-Assisted Clip Closure Technique: A New Choice for
Gastrointestinal Defect Closure
Version: 3 Date: 18 Feb 2025
Reviewer:  Teppei Masunaga
Reviewer's report:
Thank you for the chance to review your manuscript again. I have confirmed that the noted
corrections have been made. Your revised manuscript can be acceptable.
Review for 10.1186/s12876-025-03850-x (2025)

Title: Machine Learning-Based Disease Risk Stratification and Prediction of Metabolic
Dysfunction-Associated Fatty Liver Disease Using Vibration-Controlled Transient
Elastography: Result from NHANES 2021–2023
Version: 1 Date: 03 Mar 2025
Reviewer's report:
Machine learning and risk stratification for model predicting MAFLD.
This is a well written paper thank you. It adds to the growing body of work in the area. I have
a query:
Did you compare your model’s performance on the validation data set to other AI models? Or
with non-invasive biomarkers that are in use? Such as ELF, FIB-4 etc. It would interesting to
compare and comment on the differences in performance. See below:
1. Blanes-Vidal, V., Lindvig, K.P., Thiele, M. et al. Artificial intelligence outperforms standard
blood-based scores in identifying liver fibrosis patients in primary care. Sci Rep 12, 2914 (2022).
https://doi.org/10.1038/s41598-022-06998-8
2. Wong GL, Yuen PC, Ma AJ, Chan AW, Leung HH, Wong VW. Artificial intelligence
in prediction of non-alcoholic fatty liver disease and fibrosis. J Gastroenterol Hepatol. 2021
Mar;36(3):543-550. doi: 10.1111/jgh.15385. PMID: 33709607.
Review for 10.1186/s12876-025-03850-x (2025)

Title: Machine Learning-Based Disease Risk Stratification and Prediction of Metabolic
Dysfunction-Associated Fatty Liver Disease Using Vibration-Controlled Transient
Elastography: Result from NHANES 2021–2023
Version: 3 Date: 26 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03850-x (2025)

Title: Machine Learning-Based Disease Risk Stratification and Prediction of Metabolic
Dysfunction-Associated Fatty Liver Disease Using Vibration-Controlled Transient
Elastography: Result from NHANES 2021–2023
Version: 3 Date: 30 Mar 2025
Reviewer's report:
None.
Review for 10.1186/s12876-025-03793-3 (2025)

Title: Triglyceride-glucose index and triglyceride-to-high-density lipoprotein cholesterol ratio
in predicting severity of acute pancreatitis: a cross-sectional clinical study
Version: 2 Date: 05 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03842-x (2025)

Title: Global Burden of Gallbladder and Biliary Diseases (1990-2021) with Healthcare
Workforce Analysis and Projections to 2035
Version: 3 Date: 15 Mar 2025
Reviewer's report:
This manuscript provides a comprehensive epidemiological analysis of gallbladder and biliary
tract diseases based on Global Burden of Disease Study (GBD) 2021 data. The study
systematically evaluates long-term trends in incidence, prevalence, disability-adjusted life
years (DALYs), and mortality, alongside projections up to 2035 using the Bayesian Age-
Period-Cohort (BAPC) model.  The research is well-structured, and the statistical methods are
appropriately applied. However, there are methodological and interpretative limitations that
need to be addressed before the manuscript is suitable for publication.
1. The manuscript attributes the increase in absolute case numbers primarily to population
aging and growth. However, other key risk factors (e.g., obesity, metabolic disorders, lifestyle
changes) are not sufficiently discussed.
2. The manuscript relies entirely on GBD 2021 data without a critical evaluation of its
limitations. Potential concerns include: variability in data quality across different countries;
the possibility of underestimation of disease burden in regions with limited healthcare access;
potential biases introduced by data extrapolation methods. The "Limitations" section should
explicitly acknowledge these constraints and discuss their potential impact on the study’s
conclusions.
3. The study employs the BAPC model for projections, but it does not evaluate the accuracy
of the model or discuss potential sources of error. No comparison with alternative forecasting
methods is provided. The "Methods" section should briefly justify the choice of the BAPC
model, while the "Discussion" section should include its limitations and uncertainties.
4. The manuscript does not discuss how improvements in medical treatments, such as the
widespread adoption of laparoscopic cholecystectomy, may have influenced the observed trends
in DALYs and mortality. Please add a brief discussion  on the impact of improved diagnostics
and surgical treatments on mortality reduction would strengthen the interpretation of results.
5. In some parts of the text, it is unclear which changes in disease burden are due to demographic
factors (aging and population growth) versus epidemiological trends (true changes in disease
risk). Please clarify and distinguish between absolute case increases and age-standardized rates
when reporting trends. Also, it is important to explicitly state where increased case numbers are
due to demographic changes rather than increased disease incidence.
I would like to once again thank the authors for the opportunity to review their publication.
After addressing the raised questions and making the necessary revisions, the manuscript may
be considered for publication.
Review for 10.1186/s12876-025-03842-x (2025)

Title: Global Burden of Gallbladder and Biliary Diseases (1990-2021) with Healthcare
Workforce Analysis and Projections to 2035
Version: 5 Date: 29 Mar 2025
Reviewer:  Amira A. A. Othman
Reviewer's report:
I congratulate everyone involved in this work. All necessary amendments have been made
carefully and satisfactorily. I look forward to seeing this research contribute to science.
Review for 10.1186/s12876-025-03842-x (2025)

Title: Global Burden of Gallbladder and Biliary Diseases (1990-2021) with Healthcare
Workforce Analysis and Projections to 2035
Version: 5 Date: 31 Mar 2025
Reviewer's report:
Dear Authors,
The revised manuscript demonstrates a substantial and comprehensive improvement over the
initial submission. The authors have responded thoughtfully and thoroughly to all reviewer
comments. Their revisions have significantly enhanced the clarity, scientific rigor, and practical
relevance of the study.
Recommendation: Accept for publication (minor editorial revisions only, if needed)
Review for 10.1186/s12876-025-03826-x (2025)

Title: Comparative Effects of Aerobic and Resistance Exercise on Bile Acid Profiles and Liver
Function in Patients with Non-Alcoholic Fatty Liver Disease
Version: 2 Date: 11 Feb 2025
Reviewer's report:
Dear Authors,
The manuscript writing is well. Some comments for improve manuscript was attached to the file.
Best,
Review for 10.1186/s12876-025-03826-x (2025)

Title: Comparative Effects of Aerobic and Resistance Exercise on Bile Acid Profiles and Liver
Function in Patients with Non-Alcoholic Fatty Liver Disease
Version: 2 Date: 12 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The 8-week intervention period, while adequate for initial observations, may not be long enough
to capture the long-term effects of exercise on liver function and bile acid metabolism. A longer
follow-up would provide more insight into the sustainability of the benefits observed.
-While the exercise intensity for aerobic and resistance training is specified in terms of heart
rate percentage (50-70% of maximum heart rate), it would be helpful to describe how intensity
was monitored and whether it varied within the groups (e.g., considering variations in individual
fitness levels). This could affect the overall results and interpretation.
-While participants are selected based on strict criteria, the study does not mention how factors
like diet, sleep, and other lifestyle habits were controlled or monitored during the intervention.
These factors could influence the outcomes and confound the results, especially since diet and
exercise are often interconnected.
-While the study mentions the impact of aerobic exercise on bile acid metabolism, the discussion
could benefit from further exploration of other potential mechanisms of exercise-induced liver
improvement. For example, the role of exercise in reducing oxidative stress or inflammation,
both of which are central to NAFLD pathogenesis, could be addressed.
-The study suggests that exercise is beneficial for liver function but does not extensively explore
how exercise interacts with dietary habits in the context of NAFLD. Since diet plays a crucial
role in managing liver diseases, integrating a more comprehensive discussion of diet and exercise
synergy could provide deeper insights into optimal NAFLD management strategies.
-While UDCA is important, it might be premature to draw definitive conclusions about its role
in exercise-induced liver improvement based on this study alone. A more balanced view that
considers other bile acids and metabolites involved in liver function (e.g., those related to lipid
metabolism or inflammation) could provide a more nuanced understanding of the impact of
exercise on liver health.
-Although the study focuses on young individuals, the discussion could include a brief mention
of how these findings might be translated to older populations, who might have different
responses to exercise or NAFLD progression. Acknowledging this limitation would further
clarify the scope of the study’s implications.
Review for 10.1186/s12876-025-03826-x (2025)

Title: Comparative Effects of Aerobic and Resistance Exercise on Bile Acid Profiles and Liver
Function in Patients with Non-Alcoholic Fatty Liver Disease
Version: 3 Date: 19 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03826-x (2025)

Title: Comparative Effects of Aerobic and Resistance Exercise on Bile Acid Profiles and Liver
Function in Patients with Non-Alcoholic Fatty Liver Disease
Version: 3 Date: 24 Mar 2025
Reviewer:  Ayoub Saeidi
Reviewer's report:
All reviewers comments have been made by the authors. The article is acceptable in this format.
Review for 10.1186/s12876-025-03845-8 (2025)

Title: Development and verification of a radiomics model to forecast Ki67 index and prognosis
in advanced gastric tubular adenocarcinoma
Version: 0 Date: 13 Mar 2025
Reviewer's report:
The design of this study is exquisite and appealing. I have several following comments:
1. In the Introduction Section, some literature are out-of-date when   it comes to the
epidemiology of gastric cancer. I suggest citing the two latest literature"DOI: 10.1097/
MD.0000000000035585” “DOI: 10.1097/MD.0000000000038376”, which could add some
novelty to your study.
2. Disease-Free Survival(DFS) is one of the most common indicators to evaluate the prognosis
of gastric cancer. So could you further explore the association between Ki-67 and DFS? I think
it's helpful to enrich your research?
After solving the two aforementioned problems, I consider this work suitable for publication.
Thanks.
Review for 10.1186/s12876-025-03845-8 (2025)

Title: Development and verification of a radiomics model to forecast Ki67 index and prognosis
in advanced gastric tubular adenocarcinoma
Version: 1 Date: 28 Mar 2025
Reviewer's report:
Thanks for the revision work. After revising, your manuscript is well-writen. It could be
accepted.
Review for 10.1186/s12876-025-03845-8 (2025)

Title: Development and verification of a radiomics model to forecast Ki67 index and prognosis
in advanced gastric tubular adenocarcinoma
Version: 1 Date: 28 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03867-2 (2025)

Title: Cost-effectiveness of NALIRIFOX versus Nab-paclitaxel and Gemcitabine in Previously
Untreated Metastatic Pancreatic Ductal Adenocarcinoma
Version: 3 Date: 04 Apr 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03867-2 (2025)

Title: Cost-effectiveness of NALIRIFOX versus Nab-paclitaxel and Gemcitabine in Previously
Untreated Metastatic Pancreatic Ductal Adenocarcinoma
Version: 3 Date: 04 Apr 2025
Reviewer's report:
No further comments.
Review for 10.1186/s12876-025-03854-7 (2025)

Title: Application effect of Standardized Nursing Process of abdominal drainage tube in
cholelithiasis: a single-center retrospective cohort study
Version: 1 Date: 17 Mar 2025
Reviewer's report:
Major Comments
1.  Clarify the actual study timeline and ensure all data were collected retrospectively.
2.  The manuscript lacks a sample size calculation. Retrospective studies should still justify the
number of included patients to ensure statistical power. Provide a post-hoc power analysis or
rationale for the cohort size.
3.    While multivariate analyses were performed, the choice of adjusted variables (e.g., CRP
for activity rate, neutrophil percentage for pain) lacks justification. Explain why these specific
covariates were selected and whether variables like surgical duration or comorbidities were
considered.
4.    The study design does not mention whether nurses or assessors were blinded to group
allocation. Awareness of SNP/non-SNP status could introduce performance or detection bias.
Address this limitation and discuss its potential impact.
5. Categorizing continuous outcomes (e.g., VAS score, satisfaction) using median splits risks
information loss and reduces sensitivity. Consider using ordinal logistic regression or other
methods preserving data granularity.
- The use of "OR=8.66[4.38,17.11]" for satisfaction (Table 5) implies binary categorization, but
satisfaction was measured on a 4-point scale. Clarify how this was handled statistically.
Minor Comments
1.  The introduction and discussion are repetitive regarding the controversy around drainage
tube use. Condense these sections.
- Avoid phrases like "for the first time" unless supported by a systematic literature review.
2. Table 1 reports median (IQR) for non-normally distributed data, but some variables (e.g.,
CRP, HBP) show large variability. Consider presenting ranges or discussing potential outliers.
3.  Both groups had 0% infection rates (Table 2). This raises questions about surveillance
methods or follow-up duration. Address whether infections were actively monitored or
underreported.
4.   While statistical significance is highlighted, the clinical relevance of outcomes (e.g., "activity
rate of getting out of bed") needs elaboration. How does a 40.82% vs. 23.93% improvement
translate to real-world recovery?
5. Limitations Section
Expand limitations to address:
- Potential selection bias due to retrospective design.
- Lack of standardization in non-SNP care (e.g., variations in nursing practices).
- Generalizability concerns from a single-center study.
Review for 10.1186/s12876-025-03854-7 (2025)

Title: Application effect of Standardized Nursing Process of abdominal drainage tube in
cholelithiasis: a single-center retrospective cohort study
Version: 2 Date: 31 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03816-z (2025)

Title: Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients
and Actual Portal Pressure Gradient
Version: 2 Date: 28 Jan 2025
Reviewer's report:
The article by Rufeng Chen and Yaozu Liu et al. describes the correlations and relationships
between different wedged and free pressure measurements for HVPG and PPG-assessment prior
to and after TIPS implantation, respectively, including measurements within the liver vein and
the inferior caval vein.
The manuscript is very well written, concise and focusses on the topic.
The data were collected retrospectively, but - according to the authors - without sedation or
anaesthesia, which makes the measurements valuable.
The topic is clinically and scientifically of  interest, as HVPG (as an indirect measurement
of PPG) is the parameter that best correlates with outcome in patients with decompensated
cirrhosis. Correct assessment of PPG/PPG-estimation via HVPG is thus key to prognostication
and treatment of patients with cirrhosis.
Major comments:
- Most of the included patients suffered from HBV-associated cirrhosis and variceal bleeding.
How many patients were under antiviral treatment, and how many of the patients under NSBB
prophylaxis or other vasoactive drugs (e.g. nitrates) at time of measurement? Were there any
differences between patients under medical treatment and those without?
- Please add a sentence on the stated fact that TIPS were performed under local anaesthesia and
without sedation or general anaesthesia to the section "Measurement of HVPG and PPG" under
"Materials and Methods"
- Who performed the HVPG measurements and TIPS procedures? Was it hepatologists
or radiologists? Were all procedures performed by the same specialist, or how many
interventionists were involved? If more than one was involved, were there any significant inter-
intervenionist differences regarding technique or outcome parameters?
- Did any patients undergo rescue TIPS due to refractory bleeding, undergo BRTO or receive
coagulation factors, fresh frozen plasma or platelet concentrates prior to TIPS implantation?
- If there are any data available: How many patients actively consumed alcohol or smoked prior
to TIPS?
Minor comments:
- How many patients had both moderate ascites and variceal bleeding as indications for
TIPS? When patients with high-grade ascites were excluded, was abdominal paracentesis not
performed prior to TIPS insertion? And why was ascites still the indication for TIPS in 19%?
- I kindly ask the authors to check for inconsistencies with regards to abbreviations; e.g. are F-
HVPG, HVPG-free and HVPGfhvp the same value? Please unify the abbreviations throughout
the manuscript.
- Similarly, I kindly ask the authors to check the figures and adapt them regarding sizes (e.g.
Figure 4a A and B) and y-axis scaling (e.g. figures 2b C and D) for better comparability where
appropriate.
- On a related note, I suggest writing FHVP and IVCP in Figure-1 in capital letters for
consistency.
Review for 10.1186/s12876-025-03816-z (2025)

Title: Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients
and Actual Portal Pressure Gradient
Version: 3 Date: 17 Feb 2025
Reviewer's report:
The authors have almost fully addressed and revised the manuscript in response to the reviewers'
comments. I have only one additional minor comment. The modality used for 2D-SWE
measurements should be specifically clarified, including the manufacturer and location. This is
important to ensure the reproducibility of the results in the present study.
Review for 10.1186/s12876-025-03816-z (2025)

Title: Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients
and Actual Portal Pressure Gradient
Version: 3 Date: 20 Feb 2025
Reviewer's report:
The manuscript improved. Please add the following statement at the end of the abstract and
conclusion of the discussion:  "Due to the significant underestimation of the PPG, HVPG
measurement should not be used to exclude patients from a TIPS intervention".
Review for 10.1186/s12876-025-03846-7 (2025)

Title: Long-term weight change patterns in American adulthood in relation to gallstones:
evidence from NHANES
Version: 0 Date: 24 Feb 2025
Reviewer's report:
Manuscript: Long-term weight change patterns in American adulthood in relation to gallstones:
evidence from NHANES
This manuscript examined the association of body weight change and risk of developing
gallstones among U.S. adults who completed the NHANES 2017-2020. While this an interesting
and potentially valuable manuscript, improvements are needed to clearly communicate the
findings.
Comments
1. Methods, Study population- could the authors elaborate why the study included adults only
within the age range of 40-70?
2. Methods, Statistical analysis- Model 1 is completely unadjusted so it is not surprising that the
results were not statistically significant. It may be more valuable to consider adjusting Model 1
for a minimal number of covariates, such as age, sex, and race.
3. Results
a. Page 8- The first sentence seems repetitive of the Methods section.
b. Page 8- It would be helpful to mention the overall mean or median age of participants at
baseline to better understand the time frame of the weight change estimates. It also seems
important to note that approximately half of the study population were categorized as stable
non-obese.
c. Page 8-9- The second paragraph that describes the baseline characteristics seems more
appropriate as the first paragraph of the Results.
d. Page 9- Is there a reason why the characteristics of only the stable obese group are described?
Other groups appear to have similar characteristics so it seems like it would be more valuable
to highlight important differences between the groups.
e. Page 9 and 10- The ORs and 95% CIs for models 2 and 3 from Supplementary Table 4 and
Table 2 do not match the values listed in the text.
4. Discussion- could the authors comment on the time frame used in the referenced studies that
also examined weight change from early to mid-adulthood? It would be helpful to understand
whether these studies examined a similar or different time frame.
5. Table 2, Supplementary Tables 4 and 5- the asterisks used within the tables are not reflected
in the footnotes.
Review for 10.1186/s12876-025-03846-7 (2025)

Title: Long-term weight change patterns in American adulthood in relation to gallstones:
evidence from NHANES
Version: 1 Date: 26 Mar 2025
Reviewer's report:
The authors have addressed the reviewers’ comments.
It would be helpful to add information from the response about the reason for including adults
aged 40-70 to the Methods section. The entire response is not needed but some additional
information would be helpful to readers since many are likely aware that the age range of
NHANES participants is wider than 40-70 years.
Review for 10.1186/s12876-025-03824-z (2025)

Title: Burden of Gastrointestinal Cancers in Asia, 1990–2019
Version: 0 Date: 08 Feb 2025
Reviewer's report:
The study largely confirms known trends from previous studies without offering new insights or
interpretations that significantly advance the understanding of gastrointestinal cancer burden in
Asia. This may limit its impact in the field where original research and novel findings are highly
valued. Some of the data presentation lacks clarity, particularly in how the age-standardized
rates are discussed. It could be improved by consistently contextualizing these figures within
the broader epidemiological landscape of Asia to make the data more meaningful for readers.
Review for 10.1186/s12876-025-03824-z (2025)

Title: Burden of Gastrointestinal Cancers in Asia, 1990–2019
Version: 0 Date: 09 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the GBD methodology (CODEm, ST-GPR, DisMod-MR) is mentioned, it might be
helpful to briefly elaborate on these tools for readers who are unfamiliar with them. A sentence
or two explaining how these methods work or why they were chosen could help non-expert
readers appreciate the robustness of the data modeling.
-The use of "EAPC" and "APC" is clearly explained, but further elaboration on interpreting these
values and their clinical or public health implications would add more depth. For example, what
does an increase or decrease in EAPC specifically mean for the future burden of GI cancers in
Asia? This can be discussed briefly for more context.
-While the study mentions using the Population Attributable Fraction (PAF) of risk factors
for GI cancers from the GBD database, the meaning of PAF could be explained more clearly,
particularly for readers who may not be familiar with the concept. A brief sentence on how
PAF helps to quantify the contribution of specific risk factors (like smoking, diet, etc.) would
be useful.
-The mention of R version 4.2.3 for data analysis is appropriate, but more details on the specific
statistical tests or packages used within R could provide added transparency. For example, which
functions or specific libraries were used for the analysis of trends? This is important for readers
interested in replicating or understanding the study's statistical methods in more detail.
-The discussion mentions a "fluctuating" decline in the incidence and mortality of esophageal
and stomach cancers. While this is acknowledged, the reasons for this fluctuation could be
further explored. Are there specific public health efforts or changes in risk factors (e.g., diet,
smoking) that might explain the fluctuations? Providing more context around the trends could
offer more actionable insights for future research and interventions.
-While East Asia and Mongolia are highlighted as having the highest burden of GI cancers,
more detailed insights into specific countries (e.g., China, Japan, and South Korea) would add
value. The differences in healthcare infrastructure, screening programs, and lifestyle factors
across countries in East Asia could help contextualize why some areas have seen more success
in controlling GI cancer burden than others.
Review for 10.1186/s12876-025-03824-z (2025)

Title: Burden of Gastrointestinal Cancers in Asia, 1990–2019
Version: 0 Date: 21 Feb 2025
Reviewer's report:
Excellent work on the burden of GI cancers in Asia using the GBD study. I have no major
concerns with the methodology. I have a few questions for clarification/improvement of the
paper.
1 - Is there a specific reason why the authors focused on data from the 2019 GBD study and did
not evaluate data from the 2021 GBD database?
2 - It would be very interesting if the authors could stratify the analysis of GI cancer burden by
sociodemographic index (SDI) in both 1990 and 2019.
3 - No study is perfect. Please be more transparent about the limitations of this study in the
discussion and report the inherent limitations of the GBD database and study analyses in more
detail.
Review for 10.1186/s12876-025-03824-z (2025)

Title: Burden of Gastrointestinal Cancers in Asia, 1990–2019
Version: 0 Date: 24 Feb 2025
Reviewer's report:
1. In the case definition, in addition to the C code, a D code was included. The D code
corresponds to benign neoplasm, carcinoma in situ, etc., but it is uncertain whether benign or
malignant. Please comment on this issue.
2. There are limitations associated with estimating the disease burden in certain countries, as
data quality and availability can vary significantly across different regions and countries.  In
some regions, cancer registries may not be present, or they may have limited coverage and
data quality, making it challenging to provide accurate estimates for specific diseases. Please
comment on this issue.
3. A description and explanation of the risk factors from the database (GBD) will help readers
understand.
Review for 10.1186/s12876-025-03865-4 (2025)

Title: Unfavorable outcomes and their predictors in patients treated for perforated peptic ulcer
disease in Ethiopia: systematic review and meta-analysis
Version: 2 Date: 24 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03825-y (2025)

Title: An artificial intelligence model utilizing endoscopic ultrasonography for differentiating
small and micro gastric stromal tumors from gastric leiomyomas
Version: 0 Date: 13 Dec 2024
Reviewer's report:
This study created an AI model for differentiating small GST from GL. The idea is unique and
interesting, because characterizing small gastric subepithelial lesions is a challeng. However, I
found several concerns on it.
Major
#In this study, 67 patients with a GST and 75 with a GLS were enrolled. Referring to your
inclusion criteria (a), the final diagnoses were based on surgery or endoscopic resection. Please
explain whetherthe rate of GL resected by surgery is comparable to that of GST.  If those values
significantly differ, it should be a bias.
#What was the diagnostic accuracy of endoscopic ultrasonography guided tissue acquisition
(EUS-TA) for the SMTs of 20 mm or less in diameter?  Comparing diagnostic accuracy of AI
imaging and EUS-TA may strengthen role of AI imaging.
#Please make a paragraph explaining about details of all CNN models (ResNet50, DensNet201,
and VGG19).
#You evaluated LD/SD ratio. Please describe how the tumor diameter was measured. Did you
measure LD and SD on the same image; how was the EUS image selected?
#Are there any significant differences in the AUROC between the six tests in Table 1 and Figure
2, namely LR, SVM, RF, XGBoost, LightGBM and ExtraTrees?
#(Page12 Line 278) Authors mentioned that ResNet50 surpassed the other models by
demonstrating consistently high AUC scores across various cohorts. However, No apparent
difference in AUROC can been seen. Are there significant differences?
Minor
#(Page 6, Line126 and Supplementary file 1)
Figure 1 and Supplementary table 1 show the details about enrolled patients. However, the
number of enrolled patients were different between the text, and Figure 1 and Supplementary
table 1. Please check the number of enrolled patients.
#(Page 15, Line 298)
Authors need to explain what the tumor-centric approach means? What did EUS-AI focus on
for tumor-centric approach? EUS-AI focused on echoic level?
#This study focuses on GST and GL in the stomach, but SMT also includes schwannomas and
aberrant pancreas in ordinary clinical practices. Why were they not included in this study?
Review for 10.1186/s12876-025-03825-y (2025)

Title: An artificial intelligence model utilizing endoscopic ultrasonography for differentiating
small and micro gastric stromal tumors from gastric leiomyomas
Version: 0 Date: 17 Dec 2024
Reviewer's report:
I read with great interest the article by Duan et al titled “an artificial intelligence model utilizing
endoscopic ultrasonography for differentiating small and micro gastric stromal tumors from
gastric leiomyomas”. In this report, 358 EUS images were used to generate EUS-AI training
model to differentiate small (<2 cm) and micro (<1 cm) GIST and gastric leiomyoma (GL).
Thereafter, validation set 1 and 2 were formed to assess the diagnostic performance of the same.
The article is very well detailed and I congratulate the authors for this work.
I have few comments for this manuscript:
1. There is published literature on this topic comparing GIST vs GL using EUS-AI models
(PMID: 36700302, PMID: 33827140, PMID: 38828130). The authors need to explain in the text
as to how is their study different and/or if superior, from theirs.
2. Line 99: It is already proven that EUS-FNB gives superior results to EUS-FNA for SEL
diagnosis. Please correct it and quote some relevant literature on it (PMID: 35264310; PMID:
31374187).
3. Are there any cases wherein pre-op and post-op, the histopathological diagnosis changed ?
can authors apply this EUS-AI model in the pre-op EUS images to validate the final result ?
4. Supplementary table 5: Please provide relevant definitions of junior or senior doctor, by the
number of procedures performed. Moreover, ideally, trainee and experienced endoscopist should
be used for the same.
Review for 10.1186/s12876-025-03777-3 (2025)

Title: Cardiometabolic Index as a Predictor of Gallstone Risk: Evidence from NHANES 2017–
2020
Version: 1 Date: 26 Jan 2025
Reviewer:  Erfan Arabpour
Reviewer's report:
Thank you for giving me the opportunity to review this manuscript.  Following are my comments
Abstract
-What does the sentence mean? Make it more clear by paraphrasing it:"Cardiometabolic index
(CMI) is a marker that has responded to lipids and obesity in recent years"
Methods
-As I understood from the methods, the was no missing data in this study. If it is true, clearly
mention that. If not, mention is any data imputation performed? If yes, how and for which
variables?
Results
-In the result text, mention the number of patients in each group ( with/ without GB stone).
Moreover, instead of the semtence "Significant differences were observed between the groups,
highlighting distinct profiles for those with and without gallstones.", mention these variables
which were significantly different between the groups. However, no need to mention the detail
statistics, as the are presented in table 1.
-Presence of GB stone was determined by self-report in this study. Could author provide data
regarding the symptoms ( symptomatic/ asymptomatic GB stone). If the major proportion of
patients with GB stone were symptomatic, this study, in fact, assess the association of CMI and
symptomatic GB stone, not GB stone in general.
Data availability statement
-The link provided for data availability statement is flowed. The correct link is data availability
statement: https://www.cdc.gov/nchs/nhanes/index.html
Finally, I want to propose authors an interesting topic with this data: developing machine-
learning models for prediction of GB stone using NHANES data. This model, if be relatively
accurate, may be a tool for screening patients and those with high probability of GB stone,
undergo abdominal US for definite diagnosis.
Review for 10.1186/s12876-025-03777-3 (2025)

Title: Cardiometabolic Index as a Predictor of Gallstone Risk: Evidence from NHANES 2017–
2020
Version: 1 Date: 28 Jan 2025
Reviewer's report:
Thiis is a timely study. However, there are some limitations to this study.
(1) diagnosis of gallstones was based solely on self-reported data which is prone to recall bias.
(2) causal relationships cannot be established due to nature of study design
Review for 10.1186/s12876-025-03777-3 (2025)

Title: Cardiometabolic Index as a Predictor of Gallstone Risk: Evidence from NHANES 2017–
2020
Version: 1 Date: 31 Jan 2025
Reviewer's report:
This study investigates the association between the Cardiometabolic Index (CMI) and gallstones
using NHANES data from 2017 to 2020, analyzing 5,421 participants. The authors report a
significant correlation, particularly noting that individuals in the highest CMI quartile had a 90%
higher risk of gallstones compared to those in the lowest quartile. Their findings suggest that
CMI may serve as a predictive marker for gallstone risk, with a saturation effect above a certain
threshold.
The use of self-reported data for both gallstone diagnosis and comorbidities is highly
problematic. Self-reported conditions are prone to recall bias, misclassification, and
underdiagnosis, especially for asymptomatic gallstones that are often detected incidentally on
imaging. The reliability of these findings is significantly weakened by the lack of objective
clinical confirmation, making it difficult to draw robust conclusions from the reported
associations.
While the study is well-structured, its contribution to the field is questionable, as the association
between cardiometabolic risk factors and gallstones is already well established. Obesity,
dyslipidemia, insulin resistance, and metabolic syndrome are all recognized risk factors for
gallstones, and CMI essentially encapsulates these same variables. Since this study does not
introduce a novel mechanism or significantly enhance predictive capability beyond existing
models, its incremental value is minimal.
The discussion is adequately lengthy but fails to engage deeply with the broader context of
predictive indices. There are other established markers for cardiometabolic health—such as
triglyceride-glucose (TyG) index or waist-to-height ratio—that could have been compared to
CMI in terms of predictive power for gallstones. A more critical comparison of these indices
would strengthen the argument for CMI’s utility and provide a more comprehensive perspective.
Review for 10.1186/s12876-025-03777-3 (2025)

Title: Cardiometabolic Index as a Predictor of Gallstone Risk: Evidence from NHANES 2017–
2020
Version: 1 Date: 01 Feb 2025
Reviewer's report:
Thank you for the opportunity to review the article entitled "Association between
Cardiometabolic index and gallstones: insights from NHANES 2017–2020".
The "Introduction" section does not raise any objections - it effectively introduces the potential
reader to the scope of the discussed issue.
In the methodological section, the reviewer's objections are raised by the following issues:
1) The study used NHANES data (from the USA), while the authors used a cut-off point for
proper and improper BMI dedicated to their country of origin, i.e. 24 kg/m2 - it would be justified
to re-analyze the obtained database using the proper cut-off, or to distinguish different cut-off
values for different races of patients included in the analysis.
2) The authors used mean and standard deviation in the statistical analysis, but did not provide
information on the test used to assess the distribution of variables (and thus, authorizing the use
of tests and parametric data) - this should be supplemented.
The results of the study were presented in an appropriate manner (with the proviso that after
updating the data related to the comments given above, these results may and should change
slightly).
The discussion is conducted in an appropriate manner. There was no use of unjustified citations
or self-citations.
The work does not bear the marks of plagiarism, neither partial nor full.
The manuscript has the potential for publication, but requires some corrections.