Review for 10.1186/s12876-015-0287-1 (2015)

Reviewer's report
Title:Factors Impacting Physicians' Decisions to Prevent Variceal Hemorrhage
Version:2Date:28 February 2015
Reviewer: Ming-Jen Chen
Reviewer's report:
Editor, BMC Gastroenterology Feb 28, 2015
Dear Professor Chuah:
Comments to the editor:
Thank you for inviting me to review this article (Factors Impacting Physicians'
Decisions to Prevent Variceal Hemorrhage by Yan K.). Although this article is
well-written and interesting, we think it has little clinical implications when discuss
the decision marking in two treatment options which having a similar clinical
outcomes. This article focus on the behavior science of decision marking but not
provide develop interventions to improve adherence or clinical outcome. My
suggestion is Rejection.
Comments to the authors:
1. Gastroesophageal varices are a common complication of portal hypertension
and cirrhosis, prophylactic strategies to prevent first variceal bleeding are critical.
Meta-analyses show that non-selective beta-blockers and endoscopic variceal
ligation are proven to be equally effective in preventing first variceal bleeding in
patients with cirrhosis. This study used well validated BMS to evaluating the
influence of specific attributes from physician decision making. The topic is
interesting with clear structure and detailed information of procedures.
2. We really agree BWS is a choice task which was developed as an alternative
to rating scales to understand experts’ or patients’ preferences. However we
think there is severe selection bias in the study design. The majority of
participants (55%) were over the age of 50 and 70% of participants had spent at
least 10 years in practice since completing fellowship. This article only survey the
factors and attitude impacting “senior” physicians’ decisions. We do not know the
decisions or concerns of younger physician.
3. The authors presented a standardized scenario “If an upper endoscopy in a 60
year-old man with hepatitis-C cirrhosis (Child-Pugh class B) shows large
esophageal varices. We think the scenario is overemphasis on the “large”
esophageal varices. From the evidence of meta-analyses show that, both options
reduce the risk of first variceal hemorrhage in patients with medium/large varices.
We do not know the overemphasis on the “large” esophageal varices will affect
the decision marking.
4. As the authors mentioned in the article, the limitations included variability in
cost across insurance plans. The institutions’ facility and availability to perform of
EVL and the physician will perform EVL by himself or not should also be
considered. Although this article is well-written and interesting, we think it has
little clinical implications when discuss the decision marking in two treatment
options which having similar clinical outcomes. This article focuses on the
behavior science of decision marking but not develop suggestion or
recommendation to improve adherence or clinical outcome.
Yours truly,
Ming-Jen, Chen, MD, MMS
Assistant profession
Senior Attending Physician
Division of Gastroenterology
Department of Internal Medicine
Mackay Memorial Hospital, Taipei, Taiwan
E-mail: mingjen.ch@msa.hinet.net
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.