Utility of Direct Fast Scarlet Staining in the Histopathological Diagnosis of Eosinophilic Esophagitis: A Short Report
, Naoki Watanabe 1, Tomohiro Kato 2, Ryogo Aoki 1, Tomio Ogiso 2, Akihiko Sugiyama 2 and Eiichi Tomita 2Round 1
Reviewer 1 Report
Rather wordy and detailed review of EOE in the discussion not really necessary as this was more about the diagnostic aspects or a specific stain to highlight eosinophils and extensive general discussion about EOE as an entity not necessary and could be greatly shortened and would shorten the paper.
No data on the administration of PPI in these patients in the lead up to and at the time of diagnostic endoscopy as the authors described features of EOE in all patients as I understand from the methodology. EOE can take a while to remodel if PPI responsive and this may explain the endoscopic appearance if patients on a PPI. Having said that none of the patients may have been taking a PPI but this was not clarified
No list of other diagnoses as suggested in the paper other than EOE in particular for patients with <15 eosinophils per HPF.
Should have been a simple statistical comparison made between the two methods not just a descriptive report.
Not sure how degranulation of eosinophils was counted, were they distinguished from intact eosinophils? I can see areas of what appear to be degranulation on the slides and not sure if these were counted or whether a distinction was made.
I do not think Fig 1 is necessary.
Author Response
Reviewer 1:
Rather wordy and detailed review of EOE in the discussion not really necessary as this was more about the diagnostic aspects or a specific stain to highlight eosinophils and extensive general discussion about EOE as an entity not necessary and could be greatly shortened and would shorten the paper.
Thank you so much for your valuable comments on our manuscript. We have revised the paper based on your comments. We have shortened and arranged paragraphs in the Discussion section
No data on the administration of PPI in these patients in the lead up to and at the time of diagnostic endoscopy as the authors described features of EOE in all patients as I understand from the methodology. EOE can take a while to remodel if PPI responsive and this may explain the endoscopic appearance if patients on a PPI. Having said that none of the patients may have been taking a PPI but this was not clarified.
Thank you for the comment. We have added brief statement of PPI or corticosteroid therapy for EoE patients and their response.
No list of other diagnoses as suggested in the paper other than EOE in particular for patients with <15 eosinophils per HPF.
We have added the final diagnosis of all patients tested in Table 1.
Should have been a simple statistical comparison made between the two methods not just a descriptive report.
We agree with you. We have added the result of statistical analysis (Fisher’s exact probability test) in the Result section.
Not sure how degranulation of eosinophils was counted, were they distinguished from intact eosinophils? I can see areas of what appear to be degranulation on the slides and not sure if these were counted or whether a distinction was made.
We understand the comment. In the legend of Figure 2, we have described degranulation of eosinophils.
I do not think Fig 1 is necessary.
As you recommended, we have deleted Figure 1.
Reviewer 2 Report
The authors of the manuscript "Utility of direct fast scarlet staining in the histopathological diagnosis of eosinophilic esophagitis: A short report" is a very well written report on the better diagnosis of EOS using DFS.
The authors have given a very good histological comparison of H&E and DFS and its very clear from the stained histological sections that eosinophils are better recognized in DFS than H&E. This method will help to identify EOE easily with just DFS staining in the biopsy material.
Author Response
Reviewer 2:
The authors of the manuscript "Utility of direct fast scarlet staining in the histopathological diagnosis of eosinophilic esophagitis: A short report" is a very well written report on the better diagnosis of EOS using DFS.
The authors have given a very good histological comparison of H&E and DFS and its very clear from the stained histological sections that eosinophils are better recognized in DFS than H&E. This method will help to identify EOE easily with just DFS staining in the biopsy material.
Thank you so much for your kind comments that encourage our new study in the near future.
