Review for 10.1186/s12876-025-03792-4 (2025)

Title: The Impact of Refined Nursing Management on the Diagnosis of Early Gastric Cancer
under ME-NBI
Version: 1 Date: 14 Oct 2024
Reviewer's report:
I read your manuscript with great interest. The study provides valuable insights into the
integration of refined nursing management with magnifying endoscopy using narrow-band
imaging (ME-NBI) for improving diagnostic outcomes in early gastric cancer. Your work is both
timely and relevant, given the importance of early detection and its impact on patient prognosis.
I appreciate the effort and detail in this study, and I offer the following suggestions for further
improvement.
1. Clarification of "Painless Gastroscopy" in the Abstract: The term "painless gastroscopy" is
mentioned in the Abstract, but its definition is not provided. Does this term refer to gastroscopy
performed under sedation or analgesia? These medications could significantly influence both
the compliance score and the visibility score. It is important to describe the use of sedatives or
analgesics in the Methods section, as well as include this information in the patient background.
Doing so would help clarify how these factors may have impacted the study outcomes.
2. Sample Size Justification in the Materials and Methods Section: In the Materials and Methods
section, the study includes 998 patients, but there is no explanation for how this sample size
was determined. A power calculation to justify the sample size should be included to ensure the
study’s validity and statistical power. Without this information, it is difficult to assess whether
the sample size was adequate for detecting significant differences between the groups.
3. Timing of Mucosal Visibility Score Assessment: Regarding the Observation Indicator, it is
not clear at which point the mucosal visibility score was measured. Was this score assessed
before or after water flushing during the endoscopy? Typically, mucosal visibility is improved
by thorough water flushing before observation, and it is unusual for there to be such a large
difference in visibility scores between groups as seen in your study. It would be helpful to clarify
when the visibility score was assessed to ensure accurate interpretation of the results.
4. Experience Level of Physicians Assessing Visibility Scores: It is important to provide
information on the experience levels of the physicians who assessed the visibility scores. Were
the scores evaluated by a single endoscopist or by multiple physicians? If multiple, what were
their years of experience? Experience level can greatly influence the interpretation of visibility,
and this may account for variability in scoring. Including this information would strengthen the
credibility of the findings.
5. Classification of H. pylori Status in Table 1: In Table 1, H. pylori infection status is listed
as either “yes” or “no.” It is important to specify how the patients were categorized—whether
they were H. pylori naïve, currently infected, or post-eradication. These distinctions are relevant
because H. pylori status can influence mucosal appearance and could potentially affect visibility
scores. Clarifying this information would provide a more comprehensive understanding of the
patient background.
6. Medication Use and Its Impact on Visibility Scores: There is no mention of medication use
in the patient background, specifically regarding drugs that can affect mucosal visibility, such
as proton pump inhibitors (PPIs) or mucosal protective agents. Some medications can cause
significant mucus adhesion, which would impact visibility scores. Including details on patients’
medication use would be important for interpreting the visibility score results.
7. Impact of Visibility Score Improvement on Early Gastric Cancer Detection Rates: The
improvement in visibility scores reported in your study is an important finding, but it is not clear
how this impacted the detection rate of early gastric cancer. Given that the stated objective of
the study is “to explore the impact of magnifying endoscopy with narrow-band imaging (ME-
NBI) combined with refined nursing management on the endoscopic diagnosis of early gastric
cancer,” it would seem that the primary endpoint should be the detection rate of early gastric
cancer. Further explanation of how visibility score improvement translated into early gastric
cancer detection would significantly enhance the clinical relevance of the study.
I hope these comments are helpful in refining your manuscript. Thank you for the opportunity
to review this important work.