Review for 10.1186/s12876-025-03989-7 (2025)

Title: Impact of timing of endoscopy on clinical outcomes in cirrhotic patients with esophageal
variceal bleeding: a monocentric retrospective study from Vietnam
Version: 2 Date: 21 Apr 2025
Reviewer:  Sergiu Marian Cazacu
Reviewer's report:
The Title and Abstract summarize the main aspect of the work. I have three observations for
the Abstract section.
Observation 1: The abbreviation PSM (Propensity Score Matching) was used but not explained
in the Abstract (although this abbreviation is mentioned at the end of the paper). Because the
information contained by the Abstract must stand alone, I think that the full text ”Propensity
Score Matching” can be used instead of PSM.
Observation 2: The term ”physician's discretion” can be replaced by ”clinical judgement”.
Observation 3: The sentence ”Univariate and multivariate logistic regression analysis identified
low systolic blood pressure (OR=0.964; CI: 0.933-0.996)” seems to imply that low systolic
blood pressure is associated with a lower mortality risk (because of the value under 1 for the
Odds ratio), because the OR was estimated for the systolic blood pressure value; the authors can
rephrase the sentence in order to have a clearer picture of the systolic blood pressure predictive
role.
The introduction details current data regarding the risk of acute variceal bleeding,  the role of and
the timing of endoscopy in patients with cirrhosis and acute variceal bleeding. Current literature
data is clearly presented and analyzed by the authors.
The Methods described in this study are clear and replicable.
Question 1: What is the schedule of your on-call endoscopy in your hospital? Do you have a
24/7 emergency endoscopy available? The mortality risk may be influenced by the availability
of a 24/7 endoscopy service, which, unfortunately, is not available in all tertiary hospitals.
Question 2: Do you use the MELD-3 score or the original MELD (before 2016)? A formula
detailing the calculation of MELD can be useful.
The Results are clear. However, to have a better understanding of univariate and multivariate
analysis, a table detailing the data on the deceased and alive patients must be introduced in the
Results section.
Observation 2: Although there were some differences regarding 5-day therapeutic failure, in-
hospital mortality, and ICU admissions between patients with early and delayed endoscopy, the
differences were not statistically significant (as correctly pointed out by the authors). However,
the lack of statistical significance may be related to the small sample size of patient groups; this
possible explanation can be introduced in the Results or Discussion section.
The Discussions section analyzed the information presented by the authors in the Results section.
Although a clear role of early versus delayed endoscopy in patients with acute variceal bleeding
has not emerged, the importance of clinical judgement and also the influence of low systolic
blood pressure, high creatinine level, and high Child-Pugh score are emphasized by the authors.
Observation 1: The multivariate analysis seems to suggest that the Child-Pugh score was better
than the MELD score; can you comment in the Discussions section?
The Conclusions are clear.
The selected References are relevant to the study.
Tables contain clear and legible information.
Observation 1: As mentioned in the Results section comments, a new table containing data
stratified by the in-hospital mortality status is important.
No concerns about the validity of the study were detected. No concerns regarding similarities to
other published articles were found. No ethical concerns were detected.