Review for 10.1186/s12876-025-03758-6 (2025)

Title: Endoscopic treatment for gastroesophageal varices in patients with cirrhosis: a survey
comparing between developed and developing countries
Version: 1 Date: 27 Jul 2024
Reviewer's report:
The manuscript addresses an important topic in gastroenterology by comparing the approaches to
treating gastroesophageal varices (GOV) in cirrhosis patients between developed and developing
countries. The study design, involving a questionnaire-based survey, is appropriate for the
research question. The manuscript is generally well-organized and provides relevant data.
However, several areas need improvement for clarity, depth, and consistency.
Abstract:
1. The objective is not stated clearly. It should explicitly mention the purpose of comparing
practices between developed and developing countries. For example, it could be stated as
follows: “This study aims to compare the approaches of endoscopists in developed and
developing countries regarding the treatment of gastroesophageal varices (GOV) in patients with
cirrhosis”
2. The time frame and sample size are mentioned, but not prominently. This information is
crucial and should be highlighted. Emphasize the survey period and the number of respondents
early in the methods section.
3. Provide more specifics about the questionnaire's sections and the types of questions asked.
4. Offer more concrete recommendations or implications for practice and future research based
on the study's results.
Introduction:
1. The introduction provides some background but lacks recent statistics and comprehensive
context on the global burden of gastroesophageal varices (GOV) in cirrhosis. Incorporate more
recent data and references to underscore the significance of the problem globally.
2. Clearly articulate why it is important to compare these practices and what gaps in the literature
this study aims to fill.
3. Highlight the significance of understanding regional differences in GOV management and
how this can inform global health strategies.
4. The introduction mentions the high mortality rate associated with GOV but does not provide
recent statistics. Update the statistics on the mortality and incidence rates of GOV using the
latest data.
5. The reason for comparing developed and developing countries is not explicitly stated. Clearly
state the importance of identifying differences in practice between these regions and how it can
contribute to better management strategies.
6. The introduction lacks a clear structure and transitions. Organize the introduction into distinct
sections with clear transitions to enhance readability.
Methods:
1. The criteria for selecting countries and participants are not clearly explained. Provide a
detailed explanation of how countries and participants were selected, including any inclusion
or exclusion criteria.
2. Include information on how the questionnaire was developed, any validation processes
undertaken, and a description of the main sections and types of questions included.
Results:
1. Organize the results into distinct subsections with clear headings for each major finding
or category of analysis (e.g., Respondent Characteristics, Primary Prevention, Timing of
Endoscopy, Secondary Prophylaxis).
2. Provide a brief interpretation of each result immediately following the statistical data to help
readers understand the practical implications.
3. Include graphs or charts to visually represent key findings and trends, making the data more
accessible and engaging.
4. Briefly interpret the significance of the distribution of respondent characteristics and how
they might influence the study's findings.
5. Some tables are complex and lack clear labels or footnotes to aid interpretation. Ensure all
tables have clear headings, labels, and footnotes to explain any abbreviations or symbols used.
Ensure tables include all necessary data points and comparisons to fully represent the study's
findings.
6. Clearly mark statistically significant results in the tables and consider using asterisks or other
symbols to denote significance levels.
Discussion:
1. The discussion often presents findings without thoroughly interpreting their implications.
Provide a deeper analysis of the study's results, explaining what they mean in the context of
current knowledge and practice.
2. Some statements are speculative without sufficient supporting evidence from the data. Avoid
speculative claims unless they are clearly stated as hypotheses or areas for future research and
provide a rationale based on the study’s findings or existing literature.
3. The discussion does not adequately address the practical implications of the findings
for clinical practice. Clearly articulate how the results could influence clinical guidelines,
endoscopic practices, or patient outcomes, especially in the context of the differences between
developed and developing countries.
4. Provide a thorough analysis of the study’s limitations, including potential biases, sample size
constraints, and other factors that might affect the generalizability of the results.
5. Explain how the differences in primary prevention strategies between developed and
developing countries could impact patient outcomes.
6. Discuss the clinical implications of the timing differences and relate them to existing
guidelines or studies.
7. Provide context by discussing how these findings compare with recommended practices and
their potential impact on rebleeding rates.
8. Base statements about the need for continuous education on specific findings from the study
or existing literature, or clearly identify them as areas for future investigation.
Conclusion:
The conclusion would be stronger if it included specific recommendations for practice or future
research directions.
Minor grammatical errors and awkward phrasing in some sections. A thorough proofreading is
recommended.
Decision: Major Revision