Review for 10.1186/s12876-025-03936-6 (2025)

Title: INTRAVENOUS SEDATION DURING ESOPHAGOGASTRODUODENOSCOPY IS
ASSOCIATED WITH A REDUCED RISK OF MISSED GASTRIC CANCER
Version: 1 Date: 28 Feb 2025
Reviewer's report:
Reviewer Comments:
This study investigates the impact of intravenous sedation during esophagogastroduodenoscopy
(EGD) on the risk of missed gastric cancer (MGC). The authors present a compelling analysis of
MGC incidence, identifying key risk factors such as the absence of sedation and the presence of
gastric anastomosis. The study's focus on sedation as a modifiable factor influencing diagnostic
accuracy is particularly noteworthy, offering valuable insights into improving endoscopic
detection rates.
A key strength of this research is its unique perspective—while previous studies have explored
factors contributing to MGC, this study emphasizes the role of sedation, an aspect that is often
overlooked in routine clinical practice. The findings have practical implications for optimizing
EGD protocols and reducing the likelihood of undiagnosed gastric malignancies.
Despite being a single-center study, which may limit generalizability, the authors have
thoroughly analyzed their dataset and provided a well-reasoned discussion supported by robust
statistical analysis. The take-home message is clear and clinically relevant: performing EGD
under intravenous sedation can enhance the detection of gastric cancer, particularly in high-risk
patient populations.
Overall, this is a well-executed study that addresses an important clinical question with a
novel focus. The authors successfully translate their findings into actionable recommendations,
making this paper a valuable contribution to the field of gastroenterology. However, I have a
few specific comments that should be addressed before the manuscript can be considered for
publication.
Specific Comments:
1. Definition of MGC in the Abstract
It would be beneficial to include a clear definition of "missed gastric cancer (MGC)" in the
abstract. This will help ensure clarity for readers unfamiliar with the term and improve the overall
comprehensibility of the study.
2. Clarification of Univariate Analysis Findings
The manuscript states, "According to our univariate analysis, performing fewer biopsies and
performing the procedure without IV sedation were the only factors related to MGC." While the
corresponding Table includes data on biopsy counts and sedation rates for both groups, it would
be preferable to explicitly present these values in the main text as well. This will allow readers
to compare the groups more easily without having to refer to the Table.
3. Correction of p-Value Notation
The manuscript currently reports p = 0.000, which can be misleading from a statistical
standpoint. Instead, the appropriate notation should be p < 0.001.
Rationale:
The value p = 0.000 is theoretically impossible, as p-values represent the probability of obtaining
the observed result under the null hypothesis. A value of 0.000 would imply an absolute certainty
of no random chance, which cannot be conclusively demonstrated.
Standard statistical guidelines (e.g., APA, AMA, NEJM) recommend using p < 0.001 in such
cases to reflect the highly significant nature of the result without implying absolute certainty.
I appreciate the authors' work on this important topic and believe that addressing these points
will further strengthen the manuscript. I look forward to reviewing the revised version.