Review for 10.1186/s12876-023-02696-5 (2023)

Reviewer’s report
Title: 
A novel capsule endoscopy for upper and mid-GI tract: the UMGI capsule
Version: 
0 
Date: 
26 Jul 2022
Reviewer: 
Angelo Zullo
Reviewer's report:
This pilot study evaluated the feasibility and safety of a novel capsule endoscopy
to perform both gastroscopy and small bowel study in the same session with a
single device. In detail, gastroscopy was performed under the control of magnet
and string, and the small bowel study by successively delivering the device in the
duodenum. Basically, data found a good technical success (1 failure of device
detachment) and a discrete grade of tolerability. 
COMMENTS
- Every new device that improves patients' care and/or utilization of health
resources is potentially welcome. Is this rule applicable to this novel capsule
endoscopy? Most likely, the gastroscopic phase with this device is longer and
less comfortable than standard, shorter and accurate gastroscopy with conscious
sedation. These aspects should be opportunely highlighted in Discussion.
- A major limitation is the impossibility of taking gastric biopsies. While for the
small bowel this restriction is mitigated by the low prevalence of lesions, the
diseases in the stomach requiring biopsy sampling are distinctly frequent. In
detail, the lack of information on H. pylori infection and presence of
precancerous lesions (intestinal metaplasia) deeply reduces the diagnostic yield
of capsule gastroscopy. These aspects should be opportunely disclosed and
discussed.
- The impossibility of washing gastric mucosa during inspection is another
insurmountable limit of capsule as compared standard endoscopy. Please, clearly
insert this aspect among limitations. 
- In Discussion (from page 9 line 53 to page 10 line 21) the Authors focused on
papilla visualization with the novel device as compared to the standard SB
capsule. The comparison would be inappropriate since standard SB capsules are
performed only following a previous standard gastroscopy, so that the papilla
region was already evaluated at endoscopy. Therefore, all these considerations
are clinically unrewarding and should be avoided. 
- It is unclear why the small bowel study was attempted in only 22 out 30
enrolled subjects. Please, provide an explanation. 
MINOR POINTS
- Pag 9, line 3: I failed to understand the affirmation "...results confirmed the
superiority of UMGI capsule...". It appears that Authors would conclude on the
superiority of this capsule endoscopy over the standard gastroscopy. This is not
corroborated by the provided data. 
- Pag 12, line 17: 
it was affirmed that "...promoting capsule endoscopy as a real
"mouth to anus" screening tool in the future". This would appear excessive when
considering that colon is not investigated with this novel device. Please, revise
this conclusion and clearly disclose that this device is still not ready for clinical
practice. 
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Is the study design appropriate to answer the research question (including the use
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