PONE-D-23-16418Comparison of interventions for Barrett's esophagus: a network meta-analysisPLOS ONE

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Reviewers' comments:

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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

Reviewer #3: Partly

Reviewer #4: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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

Reviewer #3: Yes

Reviewer #4: Yes

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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: 1. Non-dysplastic BE does not need eradication treatment based on cost-effects ratio. The authors suggest a different opinion refering to referance 37, however, the article can not be searched. A article written by Prateek Sharma,et al. <dysplasia a="" and="" barrett="" cancer="" cohort="" in="" large="" multicenter="" of="" patients="" with="">, seems the article the authors referred, according to the observation from Prateek Sharma, there was only 18 patients of 1376 objectives had at least 2 initial consecutive endoscopies with biopsies revealing non-dysplastc mucosa. And the inaccuracy operation of endoscopic biopsy making an imoact on the result should be considered, then, this is not strong evident supporting authors opinion. It is better for the authors to review more publishes correctly.

2. Endoscopic surveillace is a effective method to detect early carcinoma also as a uesful management for patients who accepted endoscopic eradication therapy or other treatment. But, It should not be compared with other complete eradication treatment.

3. For now, The best treatment for BE should based on the grade of dysplasia and the widths and depths of the lesion. For example, Endoscopic mucosal resection (EMR) is a widely used technique for diagnosing and

eradicating superficial BE dysplasia and neoplasia, Radiofrequency ablation (RFA) can be employed to eradicate circumferential areas of dysplastic BE.

4.Photodynamic Therapy is usually applied to esophageal cancer treatment. For BE, it is a option, but not commonly accepted.

5. The authors research seems a little contributions for BE treatment reseach. Obsolete publishes included might be a reason.</dysplasia>

Reviewer #2: The author analyzed the advantages and disadvantages of different treatment methods for Barrett's esophagus using a net META method. The literature included in the study was all RCT studies, with small differences in sample size and high reliability in each study. Preliminary analysis has been conducted on the advantages of current methods for treating Barrett's esophagus. However, there are still some shortcomings in this article. In the discussion section, the current Barrett's esophageal treatment guidelines were not combined to point out the similarities and differences between your research and the guidelines.

Reviewer #3: This meta-analysis deals with a very important topic, the treatment of Barrett's esophagus. The authors compare existing treatment options in order to evaluate them on the basis of available RCTs.

The present manuscript still needs some fine-tuning in a few points:

Minor remarks:

1. Please insert a space before the brackets when introducing an abbreviation.

2. In the methods section "study selection", please define what you consider as a small sample size.

3. Statistical analysis: Here you write that it was investigated to what extent a small-sized trial influenced the results. However, in the study selection section small sized trials were excluded, please explain the discrepancy between these two points.

4. Table 1: It would be nice, if you could explain in the legend, what is meant by wrong outcome, as this term is slightly misleading.

5. MPEC is not introduced in the text.

6. For figure 2: Please consider indicating, which of the 23 studies you have considered as potentially biased.

7. It is slightly irritating, that Fig. 4A and 5A are mentioned way earlier in the text then the following numbers.

8. Figure legend 2 needs a little more information what is to see in the figure.

9. Reference in text to supplement figure 2 is missing.

10. Also discuss newer developments like Hybrid-APC:

Shimizu, T., Samarasena, J. B., Fortinsky, K. J., Hashimoto, R., Chehade, N. E. H., Chin, M. A., ... & Chang, K. J. (2021). Benefit, tolerance, and safety of hybrid argon plasma coagulation for treatment of Barrett's esophagus: US pilot study. Endoscopy International Open, 9(12), E1870-E1876.

Knabe, M., Beyna, T., Rösch, T., Bergman, J., Manner, H., May, A., ... & Ehlken, H. (2022). Hybrid APC in Combination With Resection for the Endoscopic Treatment of Neoplastic Barrett's Esophagus: A Prospective, Multicenter Study. The American journal of gastroenterology, 117(1), 110-119.

11. In your overall conclusion I am missing a statement regarding surgery as a therapeutic option.

Reviewer #4: This appears to be an article that could serve as an excellent guideline for the treatment of Barrett's esophagus (BE). However, there are a few points of curiosity that I would like to address:

1. In the "study selection", the article divided the treatments into 10 major groups. I wonder if it could have been possible to group similar treatments together to create fewer groups.

2. In the "study selection", it was mentioned that studies with small sample sizes were excluded. It would be helpful to specify the criteria used to determine what is considered a small sample size.

3. While there seems to be a fundamental difference in the meaning of "complete ablation of BE" and "complete eradication of dysplasia," in practical terms, they appear to have very similar criteria. It would be beneficial to mention the rationale for separating these two, as they seem quite similar in clinical application.

4. In Figure 1, the number of cases classified as "irrelevant" is quite high (805 cases). It would be helpful if the specific criteria used to make this determination were explicitly stated.

5. Generally, dysplasia and esophageal adenocarcinoma are assessed using different criteria. If the article refers to "complete ablation of BE" and places adenocarcinoma on the same level as dysplasia, it would be useful to explain the reasoning behind this.

6. If the article suggests that adenocarcinoma can progress directly from metaplasia without going through dysplasia, it might be more helpful to mention this in the introduction or study design section rather than just in the discussion. This could help reduce confusion.

7. If the above-mentioned points of concern are addressed, this article has the potential to be clinically very helpful.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

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Comparison of interventions for Barrett's esophagus: a network meta-analysis

PONE-D-23-16418R1

Dear Dr. Pan,

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.

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Kind regards,

Alejandro Piscoya

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #3: All comments have been addressed

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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 #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: 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 #3: Yes

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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 #3: 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: Barrett's esophagus (BE) is a precancerous condition which can develop into esophageal cancer (EC) without correct management. For now, the standard surveillance for BE is endoscopy regularly based on the grade dysplasia of BE in order to detect early carcinoma. The widely accepted treatment to BE is endoscopic eradication therapy,including APC, EMR and ESD. Radiofrequency ablation (RFA) is another option eradication of BE. Photodynamic therapy (PDT)is a rare chioce for BE. However, considering the high preveilence of esophageal squamous cell carcinoma,PDT was frequently used in China for some time past, and the Chinese researchers have more experiences in PDT. I think we can give the authors a chance to provide a different view for management of BE although their manuscript based on uncommon strategy for BE.

Reviewer #3: Thanks for including MPEC in the treatment groups, but you forgot to also included it in the abbreviations section.

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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 #3: No

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