Review for 10.1186/s12876-024-03407-4 (2024)

Title: ICG-r15 Predicts Esophageal Varices in Compensated Liver Cirrhosis: A Noninvasive
Approach
Version: 1 Date: 01 Jun 2024
Reviewer's report:
Many thanks to the authors on this interesting article on the important topic of non-invasive
predictors for esophageal varices.
Abstract:
1. There are some spelling and punctuation mistakes I have highlighted in the text for revision.
2. If the number of words in the abstract allows, please write the full medical term as well as the
acronym especially for the following: ICG-r15, CHE, ARR, EHBF, PSDR
3. The conclusion seems to be repeated, “The ICG-r15 and PLT can predict the grade of EV in
patients with compensated liver cirrhosis.” Can be omitted as the following sentence “ Although
we are far from the replacement of endoscopy, ICG-r15 combined with PLT seems to be able to
identify patients with medium or large EV in patients with compensated liver cirrhosis” suffices.
Introduction:
1. There are some spelling and punctuation mistakes I have highlighted in the text for revision.
2. A note on the complications and contraindications of using ICG dye should be added.
3. “There were some tools have been proposed’ should be corrected to “Some tools have been
proposed…”
4. “Lu et al. [16]showed that ICG retention test as a noninvasive marker for esophageal varices
in cirrhosis patients with hepatocellular carcinoma.” Should be corrected to “Lu et al. [16]
demonstrated that the ICG retention test can serve as a noninvasive marker for detecting
esophageal varices in cirrhotic patients with hepatocellular carcinoma.”
Methods:
1. The authors describe the study as a retrospective one, but I understood that the patient selection
was based on the hospital records (retrospectively), yet the ICG tests and gastroscopy were
performed prospectively, which renders this a prospective study. Please clarify this confusing
point.
2. If it is a prospective study why was the informed consent waived?
3. If it is a retrospective study, please explain why the ICG test had been performed for these
patients.
4. If the study was a retrospective one, why were the US and gastroscopy performed by the same
operator? This is only understandable in a prospective study
5. “We retrospectively selected patients who were diagnosed compensated cirrhosis” should
be corrected as follows “We retrospectively selected patients who were diagnosed with
compensated cirrhosis’.
6. There are some spelling and punctuation mistakes I have highlighted in the text for revision.
Results:
1. There is no mention of occurrence of any complications or allergic reactions to the ICG among
the study participants, please add a note as safety is imperative.
2. Did any of the patients have contraindications to the test?
Discussion:
1. The authors mentioned that using ICG-r15 combined with PLT is cost-effective for prediction
of varices. It would be beneficial to mention the difference in cost between performing these
tests and the performance of a diagnostic gastroscopy.
2. There are some spelling and punctuation mistakes I have highlighted in the text for revision.
3. “When liver function decompensate’” should be amended to “When liver function becomes
decompensated”.
4. “We hypothesized that patients with well-preserved liver function, the ICG “ should be
corrected to “ We hypothesized that among patients with well-preserved liver function, the ICG”.
Tables:
1. Some of the acronyms/ abbreviations were not clarified below the tables, for example: ICG-
K and EHBF.