Review for 10.1186/s12876-021-02085-w (2022)

Reviewer’s report
Title: 
Multi-loop traction device facilitates gastric endoscopic submucosal
dissection: ex vivo pilot study and an inaugural clinical experience
Version: 
0 
Date: 
26 Sep 2021
Reviewer's report:
This pilot study investigated the efficacy of multi-loop traction device (MLTD)
for gastric ESD using an ex-vivo porcine stomach model. The manuscript is well
written, and the results are understandable. However, several concerns should be
addressed as follows;
Major comments
1. The authors should discuss more the methodology of MLTD application in
detail. Particularly, the authors should explain where to anchor MLTD to obtain
optimal traction direction.
2. In the ex-vivo study, the authors created the lesions on the anterior and
posterior wall and performed ESD in forward view. What about the usefulness
for a lesion on the greater or lesser curvature side? Also, comment on MLTD-
assisted ESD in retroflexed view in the discussion section. 
3. The authors should discuss any disadvantages of MLTD compared with other
intraluminal traction devices. For example, MLTD can be less extended than the
S-O clip, requiring less air insufflation during ESD.
4. Reference 19 was not cited in the manuscript. I think it is very important RCT
to discuss intraluminal tissue traction.
5. In the clinical study, explain how the authors selected ten patients to attempt
MLTD-assisted ESD. Also, please discuss the selection biases.
Minor comments
1. Accidental complication can be rephrased into perforation.
2. Please discuss the cost-effectiveness of MLTD compared with other devices.
3. In Table 5, the authors should add the lesion characteristics (lesion size,
presence or absence of fibrosis, and so on). Also, the location of the lesion
(greater or lesser curvature, anterior or posterior wall) should be added to the
clinical outcomes in Table5. 
4. Traction direction can also be changed during S-O clip-assisted ESD. Please
see the reference 19 and delete the related sentence as necessary. 
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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?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
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Yes
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Yes
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from apparent manipulation?
Yes