Review for 10.1186/s12876-022-02256-3 (2022)

Title: The necessarity of treatment for small gastric subepithelial tumors#1cm-2cm# originating
from muscularis propria: An analysis of 972 tumors
Version: 0 Date: 21 Sep 2021
Reviewer's report:
The reviewer really appreciates having an opportunity to evaluate this manuscript entitled “The
necessarity of treatment for small gastric subepithelial tumors originating from muscularis
propria: An analysis of 972 tumors” written by Hu et al. There are still controversies about the
indication of endoscopic resection for small gastric SETs originating from muscularis propria.
They aimed to investigate the safety of endoscopic resection and postoperative pathology
analysis. The patients with primary small gSETs, who treated by endoscopic resection were
enrolled. A total of 936 patients with 972 gSETs # 2cm were included in our study. All the
lesions were successfully treated by endoscopic resection. Nearly half of lesions were GIST.
The incidence of intermediate/high risk GIST in the >1 and # 2cm group is 8.41 times as that
in the # 1 cm group. According to the results, they concluded that endoscopic resection is a
safe and effective treatment for small gSETs. gSETs of1-2cm is riskier than #1cm. This large-
sized retrospective study provided readers with interesting information regarding endoscopic
resection for small gSETs. However, the reviewer has some comments listed below.
1. First of all, the reviewer understood that the aim or primary endpoint of this study was
to elucidate the necessity of endoscopic resection for small gSETs because the title of this
manuscript says so and the authors describe in Introduction section that “However, few studies
have concentrated on necessity for the resection of small gSETs”. The reviewer would like to
know whether endoscopic resection is necessary or not. The authors should clearly describe an
answer to this question. Although the latest guidelines published by European Sarcoma Network
Working Group and National Comprehensive Cancer Network recommend surveillance and
follow-up as the authors describe in Introduction section, the authors have performed the
treatment for such diseases. The authors should clearly show the significance and necessity of
the treatment.
2. What is necessity of endoscopic resection for gSETs? Is it resection of GIST? If it is true,
what do the authors think regarding the finding that half of resected tumors were benign, which
did not need resection? Of course, it is easier to resect gastric GIST when the tumor is small. But
is resecting many other benign tumors acceptable to eradicate small GISTs? The issue should
be discussed sufficiently.
3. What does the result that the incidence of intermediate/high risk GIST in the >1 and # 2 cm
group is 8.41 times as that in the #1 cm group indicate? Does that mean that physicians should
consider endoscopic resection of gSETs for only the tumors of >1 and # 2 cm? The authors
should clearly describe what the result will provide something new in the daily practice for
gSETs.
4. Patients and Methods section is too simple. Are 936 patients all who had gSETs during the
study period? If the authors had other patients, the authors should describe what treatment the
patients underwent. “Endoscopic treatment” must be a sub-section of Patients and Methods
section. The authors should make subheadings, Patients, Analysis, Endoscopic treatment, and
so on. The approval number of IRB should be described. More detailed explanations regarding
the methods of endoscopic resection will help readers understand the procedures.
5. What is complete resection in Table 1, macroscopic or microscopic? If macroscopic,
pathological findings should be described.
6. What types of endoscopic resection did 5 patients who experienced complications of
endoscopic resection undergo?
7. Some basic grammatical mistakes are found (space insertion, usage of abbreviations and so
on). English proofreading by a native speaker is recommended.