Review for 10.1186/s12876-023-02696-5 (2023)

Reviewer’s report
Title: 
A novel capsule endoscopy for upper and mid-GI tract: the UMGI capsule
Version: 
1 
Date: 
20 Oct 2022
Reviewer's report:
I have read a revised version of the paper by Bin Jiang et al. about a novel string
and magnetic controlled capsule endoscopy for the study of upper and
intermediate gastrointestinal tract. 
While "standard" capsule endoscopy systems available offer a good visualization
of small bowel, the lack of control on capsule movements makes study of the
upper GI tract unreliable. Specifically designed capsules for the upper GI tract
are therefore awaited and could offer an alternative to standard upper GI
endoscopy.
The topic of the paper is therefore potentially interesting; however, the paper has
some problems that reduce its suitability for publication.
- Firsts of all, I found the paper absolutely difficult to read because of serious
linguistic problems. The authors claimed to have performed a linguistic revision,
but the second version of the paper is not so different from the first one and
many sentences are really painful to read. A serious and extensive review with
the help of an English mother-tongue reviewer is absolutely mandatory
(basically I think that almost the entire paper should be completely rewritten). 
From a clinical point of view, I agree with some of the observations already
performed by the other two reviewers. Overall, I think that the use of this capsule
to study the upper GI tract has several limitations
- While the new capsule system seems to have good diagnostic performances
compared to standard endoscopy (even if the use of healthy volunteers reduces
the strength of this statement), I see a lot of important drawbacks in terms of
comfort and organizational aspects. For example:
o Preparation: patients need to drink a large quantity of water (1 liter) in only 10
minutes before the procedure
o Very long duration of the study of UGI tract (around 20 minutes)
o Discomfort linked to the continuous movements of the string (a completely
magnetically controlled capsule would be much more comfortable)
- As already discussed, the impossibility to take biopsies is a major drawback as
compared to standard gastroscopy
Finally, I really do not understand why not all the patients underwent study of
the small bowel. Even if the authors did not feel useful in some patients to study
the small bowel, once the capsule was used I do not see the point in not
performing enteroscopy, considering the characteristics of this study (pilot study
for a new device).
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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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from apparent manipulation?
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