Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms: A single-center experience in Southern Taiwan

Chen-Yu Ko; Chih-Chien Yao; Yu-Chi Li; Lung-Sheng Lu; Yeh-Pin Chou; Ming-Luen Hu; Yi-Chun Chiu; Seng-Kee Chuah; Wei-Chen Tai

doi:10.1371/journal.pone.0275723

Peer Review History

Original SubmissionAugust 23, 2022
29 Aug 2022 Decision Letter - Hsu-Heng Yen, Editor PONE-D-22-23547Clinical outcomes of colon endoscopic submucosal dissection for colonic neoplasms: A single center experience in South TaiwanPLOS ONE Dear Dr. Tai, Thank you for submitting your manuscript to PLOS ONE. The manuscript was evaluated by two experts in this field and several questions raised. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Hsu-Heng Yen Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service. 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Upon resubmission, please provide the following: The name of the colleague or the details of the professional service that edited your manuscript A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a supporting information file) A clean copy of the edited manuscript (uploaded as the new manuscript file)” Additional Editor Comments: As the study aimed to study ESD outcome in Southern Taiwan, please provide short discussion for their result with other reports of colonic resection from the same area with similar background of ESD development, i.e. (Early report of ESD from Taiwan https://doi.org/10.1016/j.aidm.2015.01.002. ; Gastroenterol Res Pract. 2013;2013:891565. doi: 10.1155/2013/891565. Epub 2013 Feb 25.PMID: 23533391 ) [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: this article clearly showed authors experience about ESD. they concluded that EUS has clinical impact before ESD. However they did not mention the method of EUS (miniprobe or radial /linear scope). becaysee more than half of the pts lesion localized in right colon. second point, thay should clearly mention that how many cases had endoscopic procedure bedore ESD (emr or tried for polypectomy in another center) Reviewer #2: The aim of this retrospective study was to evaluate the efficacy and safety of ESD for colonic neoplasms. Some revisions are suggested before consideration for publication. 1. “Clinical outcomes of colon endoscopic submucosal dissection for colonic neoplasms: A single center experience in South Taiwan” => Revise as “Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms: A single center experience in Southern Taiwan.” 2. Please shorten the background and study aim in the abstract part. 3. Please revise “colonic” neoplasm as “colorectal” neoplasm in the title, abstract and manuscript given that rectal neoplasms have been included as well. (for example, “colonic and rectal lesions” could be revised as “colorectal lesions” in the abstract part.) 4. Please specify the “percentage” of patients with complications in the abstract part. 5. How to define “minor” perforation ? 6. Please use serrated sessile “lesions” rather than “polyps” in the manuscript and tables. 7. In “Table 2”, please specify the percentage of HGD/LGD lesions. 8. Please explain why using ESD for lesions less than 20mm. According to recommendations from international societies, colorectal LST which are less than 20mm could be managed by EMR. 9. Please define “long ESD time” in the Materials and Methods part rather than in the Result part. 10. Was submucosal fibrosis associated with long ESD time ? 11. What was the proficiency of endoscopists in EUS ? What kind the EUS used in this study (miniature probe with same frequency ? radial echoendoscope ?) ? 12. Please evaluate inter-observer and intra-observer variation for EUS interpretation. 13. Please send manuscript for English language editing. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0275723.r001
Revision 1
8 Sep 2022 Author Response For Editor Comments 1. As the study aimed to study ESD outcome in Southern Taiwan, please provide short discussion for their result with other reports of colonic resection from the same area with similar background of ESD development Ans: We provided in Page 17, Line 221 to 228 As for the result of colorectal ESD in the same area with a similar background, Choo et al. revealed en-bloc resection rate (72.7%) and R0 resection rate (66.7%) with perforation rate (15.2%) when the ESD technique was newly developed in Southern Taiwan [18]. A study by Tseng et al. showed en-bloc resection rate (90.2%) and R0 resection rate (89.1%) with perforation rate (12%) [19]. Although the studies mentioned above vary, improvements in en-bloc resection rate, R0 resection rate, and complication rate were observed in our study, contributing to the accumulation of ESD experience and improvement of ESD training programs in Southern Taiwanese hospitals. For Reviewer #1: 1. The method of EUS (mini-probe or radial /linear scope). Ans: We provided in Page 6, Line 98 to 99 Our EUS procedures used a miniature Probe (UM-2R; Olympus Medical Systems, Tokyo, Japan) and an ultrasound system (EU-ME2 Premier Plus; Olympus Medical Systems, Tokyo, Japan). 2. They should clearly mention that how many cases had endoscopic procedure before ESD (EMR or tried for polypectomy in another center) Ans: We provided in Page 5, Line 74 to 75 None of these patients received previous EMR or polypectomy. Sixteen cases underwent biopsy only, which were unrelated to submucosal fibrosis during ESD. For Reviewer #2: 1. “Clinical outcomes of colon endoscopic submucosal dissection for colonic neoplasms: A single center experience in South Taiwan” => Revise as “Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms: A single center experience in Southern Taiwan.” Ans: We already revised in Page 1, Line 1 to 3. 2. Please shorten the background and study aim in the abstract part. Ans: Already shortened as Page 2, Row 21 to 24. 3. Please revise “colonic” neoplasm as “colorectal” neoplasm in the title, abstract and manuscript given that rectal neoplasms have been included as well. (For example, “colonic and rectal lesions” could be revised as “colorectal lesions” in the abstract part.) Ans: Already revised and highlighted in file: Revised Manuscript with Track Changes 4. Please specify the “percentage” of patients with complications in the abstract part. Ans: Already Specified in Page 2, Line 31 to 33. 5. How to define “minor” perforation? Ans: Mentioned in Page 9, Line 140 to 142. Our minimal perforation was defined as muscle layer defect without observation of mesenteric fat or intra-peritoneum organ and pneumoperitoneum. 6. Please use serrated sessile “lesions” rather than “polyps” in the manuscript and tables. Ans: Already revised and highlighted in file: Revised Manuscript with Track Changes 7. In “Table 2”, please specify the percentage of HGD/LGD lesions. Ans: Already revised and highlighted in file: Revised Manuscript with Track Changes 8. Please explain why using ESD for lesions less than 20mm. According to recommendations from international societies, colorectal LST which are less than 20mm could be managed by EMR. Ans: Explained in Page 5, Line 78 to 81. We chose ESD over EMR in some colorectal lateral spreading tumors less than 20 mm in cases of suspected lesions with limited submucosal invasion or difficult locations for en-bloc EMR, such as ileocecal valve, hepatic/splenic flexure, and sigmoid colon. 9. Please define “long ESD time” in the Materials and Methods part rather than in the Result part. Ans: Revised in Page 7 to 8, Line 120 to 122. 10. Was submucosal fibrosis associated with long ESD time? Ans: Mentioned in Page 19, Line 260-262 Although a study in Japan revealed fibrosis as a factor influencing long procedure times, there was no statistical significance in our study due to the limited cases of submucosal fibrosis. 11. What was the proficiency of endoscopists in EUS? What kind the EUS used in this study (miniature probe with same frequency? radial echoendoscope?)? Ans: We provided in Page 6, Line 96 to 99 EUS procedures were performed by two experienced endoscopists who have performed more than 2000 EUS procedures. Our EUS procedures used a miniature Probe (UM-2R; Olympus Medical Systems, Tokyo, Japan) and an ultrasound system (EU-ME2 Premier Plus; Olympus Medical Systems, Tokyo, Japan). 12. Please evaluate inter-observer and intra-observer variation for EUS interpretation. Ans: We selected those six cases of discordance to evaluate inter-observer and intra-observer variation. The Table was provided in file: Respond to Reviewers 13. Please send manuscript for English language editing. Ans: Already done and the revision was highlighted in file: Revised Manuscript with Track Changes Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0275723.r002
19 Sep 2022 Decision Letter - Hsu-Heng Yen, Editor PONE-D-22-23547R1Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms: A single-center experience in Southern TaiwanPLOS ONE Dear Dr. Tai, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Some minor comments require further revision and we invite you to submit a manuscript revision according to reviewer's comments. Please submit your revised manuscript by Nov 03 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Hsu-Heng Yen Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: this revised form can be published . this is valuable as real life data. authors teplied all quesıns. Reviewer #2: 1) Please use pathological findings as standard reference and calculate the interobserver and intraobserver variation which presented as kappa value. 2) Please provide a more clean version of manuscript with language editing parts deleted. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Filiz Akyuz Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0275723.r003
Revision 2
20 Sep 2022 Author Response For Reviewer #2: 1) Please use pathological findings as standard reference and calculate the interobserver and intra-observer variation which presented as kappa value. Ans: We used SPSS to calculate Kappa value. Intra-observer (Previous interpretation and interpretation in 2022): Kappa value: 1 Inter-observer (Previous interpretation and interpretation by another EUS endoscopist in 2022): Kappa value: 0.897 2) Please provide a cleaner version of manuscript with language editing parts deleted. Ans: I had provided two versions of manuscript; one is clean version (File name: manuscript) and another one is track-change version (File name: Revised Manuscript with Track Changes). Attachments Attachment Submitted filename: Response to reviewer (minor revision).docx https://doi.org/10.1371/journal.pone.0275723.r004
23 Sep 2022 Decision Letter - Hsu-Heng Yen, Editor Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms: A single-center experience in Southern Taiwan PONE-D-22-23547R2 Dear Dr. Tai, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Hsu-Heng Yen Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0275723.r005

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