Review for 10.1186/s12876-020-01582-8 (2021)

Reviewer’s report
Title: 
Endoscopic ultrasound-guided fine-needle aspiration of pelvic lesions via the upper and lower
gastrointestinal tract approaches
Version: 
0 
Date: 
17 Aug 2020
Reviewer's report:
In this paper Mita and colleagues discuss about the efficacy of EUS-guided FNA for pelvic lesions using
both an upper and a lower approach. The paper topic is potentially interesting because it highlights the
possibility of these two approaches in a location which is usually uncommon and challenging.
However, even if the topic is interesting, there are some major concerns that should be considered before
eventual publication:
1) As mentioned by the authors limitations of the study are represented by the retrospective design, the
small number of patients and that the final diagnoses were determined according to both surgical and
FNA results. 
2) Other limitations are represented by: the wide period of inclusion (10 years), the use both of FNA and
FNB needles.
3) Authors affirm that, regardless the use of FNA or FNB needle, in the study a high percentage of
hystological specimens were obtained (superior than those reported in literature for FNA).However, over
the years the concept of CORE has changed and only recently has been standardize (Fabbri C, Luigiano C,
Maimone A, et al. Endoscopic ultrasound-guided fine-needle biopsy of small solid pancreatic lesions
using a 22-gauge needle with side fenestration. Surg Endosc. 2015;29(6):1586-1590.
doi:10.1007/s00464-014-3846-6). There was a definition of CORE in the study period? If yes, specify.
4) In methods please indicate: type of technique used for tissue sampling (slow-pull, suction or wet), the
presence/absence of ROSE during the procedure.
5) authors affirmed that the final diagnoses were determined according to both surgical and FNA results.
However, in one patient with a false negative result underwent to mucosal biopsy of the small intestinal
lesion during double-balloon enteroscopy with a final diagnosis of malignant lymphoma. Why in this
patient was decided to perform a second procedure? Specify in the text.
6) The overall technical success in the study was 91.8%. However, the technical success in the upper-GI
route was lower than 90%, while in the lower-GI procedure was up to 95.2%. Can authors explain why
this difference is present? The difference of mean size of the lesions between the two groups can be liked
the technical success? 
7) In two patients EUS-FNA through the upper-GI was not possible because of the presence of vessels in
the puncture route. Why was not performed a second attempt using the lower-GI route?
8) Moreover, in the discussion authors affirmed that "Our high feasibility might be not applicable for
other centers, considering our extensive experience with EUS-FNA using a 19-gauge needle". This
affirmation need to be supported by evidences [see article: Attili F, Fabbri C, Yasuda I, et al. Low
diagnostic yield of transduodenal endoscopic ultrasound-guided fine needle biopsy using the 19-gauge
Flex needle: A large multicenter prospective study. Endosc Ultrasound. 2017;6(6):402-408.
doi:10.4103/eus.eus_54_17].
9) References, especially in the discussion, need to be improved because is lacking of many important
studies that has been recently published on EUS-guided tissue sampling.
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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?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes