Review for 10.1186/s12876-023-02855-8 (2023)

Reviewer’s report
Title: 
Construction and external validation of a nomogram model for predicting
the risk of esophageal stricture after endoscopic submucosal dissection: A
multicenter case-control study
Version: 
0 
Date: 
17 Apr 2023
Reviewer's report:
The authors developed a nomogram for predicting esophageal stricture after
esophageal ESD. While the manuscript is interesting, I have some questions and
comments. 
1. The authors stated in Table 1 that values that are not statistically significant
may be excluded. However, results that were statistically significant in the
Univariate analysis were omitted in the multivariate analysis (e.g. steroid,
positive margin, fruit and vegetable, fried food, pickled food, etc). Please explain
why some were included and why some were excluded. 
2. Steroid injection was a high risk factor for esophageal stricture, most likely
because steroid was injected into patients who initially had a high risk of
stricture such as large circumference or length. Steroid injection is thought to be
preventive, but this study shows opposite results. Was steroid indeed ineffective?
3. Fruit and vegetable intake seems to be protective, while pickled food and fried
food seem to increase the risk of stenosis. However, the authors state that only
hot water intake was a factor for esophageal stricture. Please clarify. 
4. Patients with positive margins would be at higher risk of dysphagia, especially
in those with esophageal cancer, as they have a higher risk of recurrence.
Therefore, those with recurrence at follow-up should be excluded. 
5. Over 2/3 of patients were over 60 years of age. Dysphagia may result from
other diseases such as Parkinsonism or stroke. As those over 60 are at high risk
of such diseases, the authors should check if dysphagia was mechanical in origin
and not caused by neurologic causes.
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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
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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