Review for 10.1186/s12876-022-02232-x (2022)

Title: Long-term outcomes of refractory esophageal strictures after endoscopic submucosal
dissection of superficial esophageal neoplasms
Version: 4 Date: 16 Jan 2022
Reviewer's report:
General comments:
The manuscript was well revised, however it requires some minor revisions yet. Please provide
further attention as described below.
Specific comments:
1. RES was described as an abbreviation first at BACKGROUND section, line 77, page 4. Please
provide full spelling of RES at this point.
2. The authors provided the incidence of the patients who resulted in RES with or without
prophylactic oral steroid therapy at line 175-177, page 7. Please adds the P value of the difference
of RES incidence rate between the two examined with Fisher's exact test.
3. The authors showed the R0 resection rate for RES cases at line 185, page 8. Please add this
R0 resection rate to Table 1.
4. At line 186, page 8, the description “repeated electric coagulation occurred in 48% of cases”
would be hard to understand. Does this description mean that the operator performed coagulation
hemostasis intentionally to prevent posterior bleeding in 48% of cases? Please describe it clearly.
5. The authors showed the dysphagia-free period of patients with oral steroid therapy and that
with dilation only at line 221-223, page 9. Please show whether there is a statistically significant
difference between the two.
6. The authors described “After adjusting influence on the two groups, we found the dysphasia-
free period of steroid group was 2.9 months, and the dilation alone group was 3.1 months.” at
DISCUSSION section, line 264-266, page 10. What method did the authors use to adjust it?
Was there any statistically significant difference between the two? Please describe more detail.
7. The authors added the reasons why the elderly and female patients have shorter dysphagia-
free periods compared with young and male patients at Discussion section, line 257-260, page
10. The authors described “In clinical practice, we found the elder and the female gender might
be more anxious and pay more attention to their feelings.” Is there any medical evidence for this
statement? If there is no medical basis and it is based on impression in clinical practice, it is
preferable to deleted and only state that the definite reasons for this were unclear and awaiting
further study.
8. The authors described “current evidence still suggest that prophylactic steroid therapy could
not reduce the frequency of dilations or change the long-term outcomes.” at DISCUSSION
section, line 268-270, page 10-11. If there are any other reports that show this result other than
this study, please provide the references. If not, please change the statement to " our study "
instead of " current evidence ".
9. The authors added the statement “Third, in multivariate analysis, 5 explanatory variables
might be a bit overfitting for 50 cases.” at Discussion section, line 327-328, page 13. However,
this statement is misleading. 5 explanatory variables might be a bit overfitting not for 50 RES
cases but for 30 cases with endoscopic therapy successes as the event. We hope it will be fixed.