Review for 10.1186/s12876-021-01602-1 (2021)

Reviewer’s report
Title: 
Antibiotics for fever in patients without perforation after gastric
endoscopic submucosal dissection and endoscopic submucosal excavation may
be unnecessary: A propensity score-matching analysis
Version: 
0 
Date: 
19 Oct 2020
Reviewer's report:
This was a retrospective case-control study using propensity score matching,
aimed to investigate the need for antibiotics for post-ESD fever. After matching,
192 patients with fever after ESD were included, and divided into two groups
(non-antibiotics vs. antibiotics). Whereas the duration of fever was not different
between the two groups, the median hospital stay was longer in the antibiotics
group than in the non-antibiotics group. Although the topic was of interest, there
were some concerns risen during the review process.
[Major]
#. The inclusion criteria is not clear. The authors said that who underwent ESD
for gastric lesions were enrolled over 5 years. What is included in 'gastric
lesions'? Does it includ dysplasia, cancer, subepithelial lesion, etc.? And I don't
think the majority of the patients underwent ESD. Instead, it seems that ESE or
EFTR was performed in many of the cases, considering that perforation occured
in 43.9% of the patients.
The inclusion criteria should be clearly described.
#. The expression 'ESD' might be changed or re-considered throughout the
manuscript and the title, considering the above mentioned point.
#. Is that true that the patient's body temperature was recorded only once a day
(Methods section), even in patients with documented fever? This is somewhat
surprising.
#. The patients were excluded if they (4) were immunodeficiency status; (5) had
serious cardiovascular, cerebrovascular, or hepatorenal diseases. So, the result of
this study cannot be applied to all patients. 
#. I don't understand the meaning of "second-generation antibiotics", which is
not a widely used medical term.
#. The result of this study can be summarized as follows: "The duration of
hospitalization was longer in the antibiotics group than in the non-antibiotics
group." 
#. The majority of the patients had mild fever (<38.5'C). Only 16 patients were
included in the subgroup analysis (>38.5'C), which might be the reason for
failing to show the statistical significance in the subgroup analysis. This makes it
difficult to apply the result of the study to the patients with high fever or overt
infection sign.
#. Considering these limitations (excluding the patients with serious
comorbidities, most of the subjects with fever < 38.5'C), the authors should be
very cautiously interprete the result of this study.
I think the conclusion is not appropriately drawn, and it is too exacerated. The
tone of the conclusion should be weakened, too.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
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