Review for 10.1186/s12876-025-03591-x (2025)

Title: Evaluation of Double-Balloon Enteroscopy in the Management of Type 1 Small Bowel
Vascular Lesions (angioectasia): A Retrospective Cohort Study
Version: 2 Date: 01 Nov 2024
Reviewer's report:
Review and Comments on Manuscript
This study provides valuable insights into the diagnosis, classification, and management of small
bowel vascular lesions (SBVLs) through double-balloon enteroscopy (DBE). By retrospectively
analyzing data from 67 patients with SBVLs, it investigates both the characteristics and
endoscopic treatment outcomes, particularly focusing on predictors of rebleeding.
Strengths of the Study
Comprehensive Classification and Use of Yano’s System
The study addresses the variability in nomenclature for gastrointestinal vascular lesions,
a frequent challenge in medical literature. By applying the Yano classification system, it
contributes to a more structured understanding of SBVLs. This classification not only aids in
diagnosis but also potentially standardizes treatment approaches, enhancing the study's clinical
relevance.
Identification of Recurrence Predictors
One of the study’s key findings is its identification of independent risk factors associated
with rebleeding, such as anticoagulant use, chronic renal failure, and lesion localization in the
duodenum or ileum. This aspect of the study is highly significant, as it highlights factors that
can help clinicians stratify patients by rebleeding risk, ultimately guiding treatment decisions
and follow-up protocols.
Thorough Methodology and Statistical Analysis
The authors utilize a detailed statistical approach, including multivariate logistic regression,
which strengthens the reliability of their findings on rebleeding predictors. This statistical
rigor provides a clearer understanding of SBVLs' risk profile and the effectiveness of DBE in
managing these lesions.
Real-World Clinical Relevance
The study focuses on patients who underwent endoscopic treatment, capturing a realistic
perspective on managing SBVLs with DBE. This focus is particularly beneficial as it reflects a
therapeutic approach widely applicable in clinical settings and reinforces the clinical value of
DBE in diagnosing and treating small bowel bleeding.
Limitations and Areas for Improvement
Single-Center, Retrospective Design
Being a retrospective study from a single institution, the findings may not fully generalize to
broader populations. Including multiple centers and prospective designs could help validate and
strengthen the results, particularly the predictive factors for rebleeding.
Small Sample Size and Lack of Randomized Control
The relatively small cohort and lack of randomization could limit the robustness of the
conclusions. Randomized controlled trials are needed to compare different endoscopic
treatments and evaluate long-term outcomes more comprehensively.
Lack of Gold Standard Treatment Protocol
Given that endoscopic procedures like argon plasma coagulation (APC) and clipping were
selected based on the endoscopist's discretion, it remains unclear which therapeutic approach
may be superior. Establishing a more standardized treatment protocol could enhance consistency
in outcomes and facilitate comparisons across studies.
Follow-Up Duration Variability
Differences in follow-up durations may affect rebleeding rates. Standardizing the follow-up
period could provide a more accurate representation of the long-term effectiveness of DBE and
better assess rebleeding rates post-treatment.