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: 
10 Oct 2020
Reviewer's report:
Authors concluded that antibiotics for fever after gastric endoscopic submucosal
dissection (ESD) may be unnecessary. This study is very interesting, but there
are several
critical issues related to this study.
1. Most endoscopists agree to use antibiotics when the overt perforation during
ESD for gastric epithelial neoplasm. However, there is a controversy about
antibiotics use when the fever occur after ESD without perforation. A
microperforation was also indefinite indication of antibiotics use. In this study, a
perforation is defined as other organs, extraluminal fat, or extraluminal space
outside the muscle layer that can be seen through endoscopy during the ESD,
regardless of air accumulation in the abdominal cavity. The intact serosal layer
that prevents the free air accumulation under diaphragm is considered as
perforation in this definition. A exclusion of cases with over perforation or free
air can make the conclusion clearly.
2. Antibiotics are related with longer hospital stay in this study. However, there
is no evidence to state that antibiotics is not the cause of longer hospital stay.
Other condition such as higher proportion of overt perforation cases can be the
reason of this relationship.
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Is the study design appropriate to answer the research question (including the use
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