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: 
03 Feb 2023
Reviewer's report:
Manuscript: BMGE-D-22-00386R1
Full Title: A novel capsule endoscopy for upper and mid GI tract: the UMGI
capsule
This pilot study assessed the feasibility and safety of a new capsule endoscopy
system designed to ameliorate the evaluation of upper g.i. tract via magnet and
string control, and small bowel after device detachment in duodenum.
The field is of great interest since minimally invasive procedure as well as
optimization of g.i. tract exploration are desirable.
The papers has been reviewed by 2 reviewers and authors provided a point-by-
point reply to reviewers' comments
However, there are still some issues to be addressed
MAJOR COMMENTS:
1. Authors still emphasized the utility of the device in exploring upper g.i tract,
their primary study outcome. Except for the reverse view of the duodenum - as
underlined by authors - this device is of difficult comparison with a "traditional"
upper gi endoscopy, 
in absence of inflation, aspiration, washing, targeted
biopsies. 
2. In their conclusion, authors suggest use of the device in patients taking
antithrombotic drugs, however antithrombotic therapy (as well as
anticoagulation) is not a contraindication to upper g.i. endoscopy
3. The described procedure implies patient swallowing the device in left lateral
position and required thereafter repeated water ingestions. This may raise some
safety issues: was the position maintained during water ingestion? did the
authors observed inhalation episodes? which position was required during the
entire duration of the procedure?
4. At the moment, based upon their data, their device - proposed to study the
upper g.i. tract - does not seem to offer a real advantage compared to the
"traditional " upper gi endoscopy, excdept for the reverse view of duodenum.
Therefore in my opinion the technique is promising but authors should carefully
specify that at the moment is not yet comparable to upper gi endoscopy and
could be limited to a subgroup of patients unwilling to undergo traditional
endoscopy.
Thus, should again adjust their conclusions and better underline the limits of the
technique. 
MINOR COMMENTS
1. The primary study outcome was to assess the technical success of th e device.
However, small bowel exploration, which is the main indication for capsule
endoscopy, is still not well described. Markers for complete small bowel
visualization should be mentioned. Furthermore, it is unclear whether they use
the magnet tool to ameliorate small bowel visualization. 
2. Page 5 line 42: are subjects without gastrointestinal symtoms healthy
volunteers? 
this should be specified.
3. Page 10 line 509-53: lymphangiectasia are mentioned twice after the text
revision, while angiodysplasia "disappeared": "four lymphangiectasia, one
xantoma and three angiodysplasia lymphangiectasia". 
Please specifiy the correct
results. 
Declaration of competing interests
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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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