Review for 10.1186/s12876-019-1020-2 (2019)

Reviewer ’s report  
 
Title: Antiviral therapy reduces rebleeding rate in patients with hepatitis B -related cirrhosis with 
acute variceal bleeding after endotherapy  
 
Version: 0 Date: 27 Sep 2018  
 
Reviewer: Armand Abergel  
 
Reviewer's report:  
 
The study is very interesting and try to answer to a question : can the treatment of hepatitis B 
reduce the risk of rebleeding in patients with cirrhosis  
The main problem of this study is to try to limit selection bias and confounding bias  
 
Major comments:  
- A flow chart is needed to know exactly how the patients were selected  
- Please ask for help by a statistician  
- As suggested by many statisticians, you should present in a table the different variables before 
and after adjustement or weighting  
A table with th e following data can be presented  
Variable  
Before weighting or matching : no rebleeding, rebleeding, absolute standardised difference  
After weighting or matching : no rebleeding, rebleeding, absolute standardised difference  
There is no need to present a p value  as suggested by Austin et al. 2011  
- Several methods can be used to adjust or stratify with the propensity score (Austin PC et al. 
Multivariate Behavorial Research 2011) : IPTW, stratification on the propensity score, covariate 
adjustement, propensit y score matching. Can you analyse the data with IPTW. This method has 
the advantage to keep nearly all the patients in the analysis  
- Several parameters were not used in the model (see DE JONGH Gastroenterology 
1992;103:1630 -5) : age, BMI, diabètes, bilirub in, alcohol consumption, ALAT, ASAT, ascites  
- Why you didn't study survival ?  
- Then can you study the data according to mortality as a competing risk ? (Austin PC, Statistics 
in Médicine 2017: Fine Gray model)  
- Present a sensitivity analysis for viral load and age for example and say exactly how many 
patients have had a viral load mesure  
- I don't really understand why some patients were treated by EVL and others by EVS or by both  
- If you have included successive  patients, why did you exclude the 92 patients who rebleed in 
the first year  
- Is there any interest to give details for the patients before the adjustement with the propensity 
score ?  
 
 
Minor comments :  
- Replace rehemmorhage by rebleeding  
- The English wil l be reviewed by an English native  
- Can you give more precisions for the definition of cirrhosis  
- In the discussion you say that during the follow -up you can modify the treatment of the varices 
: EVS or EVL or both. I am not sure that there are many data t o support this point of view or 
maybe there are differences between patients from Asia and Europe/USA  
- Figures 2, 3 and 4 : only one figure could be enough  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary c ontrols?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statist ics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical re view  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the follo wing questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial com peting interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
NO CONFLICT OF INTEREST  
 
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