Reviewer’s report
Title: 
Case series of aortoenteric fistula: A rare cause of gastrointestinal bleeding
Version: 
0 
Date: 
30 Aug 2020
Reviewer's report:
In this retrospective series, the Authors report data on their experience with
Aortoenteric fistula, a rare condition which is often both difficult to diagnose
and to treat. 
While it is certainly interesting to to acquire more information about relatively
rare cases of gastrointestinal bleeding ni order to orient the management of
future patients, 
I have some concerns about the data reporting in this manuscript.
Major issues:
1. First of all, it would be useful to know how many cases of gastrointestinal
bleeding were observed in the same timespan of 14 Years as the 9 cases of
aortoenteric fistula occurred, in order to have an idea of the number of cases
treated by the Center
2. In case of Aortoenteric fistula, the main problem for the physicians is that
symptoms are often initially subtle and may get unrecognised until at same point,
there is a serious manifestation. In the Manuscript , data about the timing
between the onset of first symptoms (and which were the first symptoms) and
the onset of further symptoms and/or major complications are not clearly
reported, I only find a single sentence t the beginning of the results section. I
think these data should be described in the foreground, because this information
would actually help recognise this condition in patients with unspecific
symptoms. Moreover, as concerns secondary fistulas, data about the time
between the implantation of graft/surgery and the onset of symptoms is also
important. 
3. Diagnosis: it is unclear why only six patients underwent gastroscopy and only
four patients underwent colonoscopy, while none of the patients underwent
push-enteroscopy, single/double balloon enteroscopy or capsule endoscopy
considering the high number of negative results. Is it because patients developed
shock and were sent directly to CT? Please specify and comment. 
4. Surgical treatment: this paragraph is rich in information, but extremely
difficult to read and confusing, I suggest rewriting it in a clearer way, maybe
grouping the treatment for primary and secondary cases and the cause of death.
Moreover, also in this case the time between onset of symptoms and death or, if
treated, between intervention and death should be clearly reported in the
manuscript. 
5. Please provide a language revision by native speaker, there are many grammar
and syntax mistakes
Minor comments: 
1. Background: many sentences provide data and classifications with our
references. References should be added
2. Background: I believe that the term "the incidence" may be used incorrectly, is
it a prevalence? Please specify
3. Results: Are "Bacterial pathogen results" are all the results of blood cultures?
Please specify
4. Results: "Ulcer stage A2" please add the reference for this classification
5. Discussion: "The third segment of the duodenum...should be taken seriously",
please reformulate
6. Abbreviations: plase correct the meaning of the abbreviation EGD, which is
correct in the text
7. Figure legends: Figure 3 Thrombosis should probably be replaced by
thrombus?
8. Tables: the presence of so many abbreviations makes it difficult to read the
tables
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Publons’ privacy policy 
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Yes
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Case series of aortoenteric fistula: A rare cause of gastrointestinal bleeding
Version: 
0 
Date: 
30 Aug 2020
Reviewer's report:
In this retrospective series, the Authors report data on their experience with
Aortoenteric fistula, a rare condition which is often both difficult to diagnose
and to treat. 
While it is certainly interesting to to acquire more information about relatively
rare cases of gastrointestinal bleeding ni order to orient the management of
future patients, 
I have some concerns about the data reporting in this manuscript.
Major issues:
1. First of all, it would be useful to know how many cases of gastrointestinal
bleeding were observed in the same timespan of 14 Years as the 9 cases of
aortoenteric fistula occurred, in order to have an idea of the number of cases
treated by the Center
2. In case of Aortoenteric fistula, the main problem for the physicians is that
symptoms are often initially subtle and may get unrecognised until at same point,
there is a serious manifestation. In the Manuscript , data about the timing
between the onset of first symptoms (and which were the first symptoms) and
the onset of further symptoms and/or major complications are not clearly
reported, I only find a single sentence t the beginning of the results section. I
think these data should be described in the foreground, because this information
would actually help recognise this condition in patients with unspecific
symptoms. Moreover, as concerns secondary fistulas, data about the time
between the implantation of graft/surgery and the onset of symptoms is also
important. 
3. Diagnosis: it is unclear why only six patients underwent gastroscopy and only
four patients underwent colonoscopy, while none of the patients underwent
push-enteroscopy, single/double balloon enteroscopy or capsule endoscopy
considering the high number of negative results. Is it because patients developed
shock and were sent directly to CT? Please specify and comment. 
4. Surgical treatment: this paragraph is rich in information, but extremely
difficult to read and confusing, I suggest rewriting it in a clearer way, maybe
grouping the treatment for primary and secondary cases and the cause of death.
Moreover, also in this case the time between onset of symptoms and death or, if
treated, between intervention and death should be clearly reported in the
manuscript. 
5. Please provide a language revision by native speaker, there are many grammar
and syntax mistakes
Minor comments: 
1. Background: many sentences provide data and classifications with our
references. References should be added
2. Background: I believe that the term "the incidence" may be used incorrectly, is
it a prevalence? Please specify
3. Results: Are "Bacterial pathogen results" are all the results of blood cultures?
Please specify
4. Results: "Ulcer stage A2" please add the reference for this classification
5. Discussion: "The third segment of the duodenum...should be taken seriously",
please reformulate
6. Abbreviations: plase correct the meaning of the abbreviation EGD, which is
correct in the text
7. Figure legends: Figure 3 Thrombosis should probably be replaced by
thrombus?
8. Tables: the presence of so many abbreviations makes it difficult to read the
tables
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Case series of aortoenteric fistula: A rare cause of gastrointestinal bleeding
Version: 
0 
Date: 
30 Aug 2020
Reviewer's report:
In this retrospective series, the Authors report data on their experience with
Aortoenteric fistula, a rare condition which is often both difficult to diagnose
and to treat. 
While it is certainly interesting to to acquire more information about relatively
rare cases of gastrointestinal bleeding ni order to orient the management of
future patients, 
I have some concerns about the data reporting in this manuscript.
Major issues:
1. First of all, it would be useful to know how many cases of gastrointestinal
bleeding were observed in the same timespan of 14 Years as the 9 cases of
aortoenteric fistula occurred, in order to have an idea of the number of cases
treated by the Center
2. In case of Aortoenteric fistula, the main problem for the physicians is that
symptoms are often initially subtle and may get unrecognised until at same point,
there is a serious manifestation. In the Manuscript , data about the timing
between the onset of first symptoms (and which were the first symptoms) and
the onset of further symptoms and/or major complications are not clearly
reported, I only find a single sentence t the beginning of the results section. I
think these data should be described in the foreground, because this information
would actually help recognise this condition in patients with unspecific
symptoms. Moreover, as concerns secondary fistulas, data about the time
between the implantation of graft/surgery and the onset of symptoms is also
important. 
3. Diagnosis: it is unclear why only six patients underwent gastroscopy and only
four patients underwent colonoscopy, while none of the patients underwent
push-enteroscopy, single/double balloon enteroscopy or capsule endoscopy
considering the high number of negative results. Is it because patients developed
shock and were sent directly to CT? Please specify and comment. 
4. Surgical treatment: this paragraph is rich in information, but extremely
difficult to read and confusing, I suggest rewriting it in a clearer way, maybe
grouping the treatment for primary and secondary cases and the cause of death.
Moreover, also in this case the time between onset of symptoms and death or, if
treated, between intervention and death should be clearly reported in the
manuscript. 
5. Please provide a language revision by native speaker, there are many grammar
and syntax mistakes
Minor comments: 
1. Background: many sentences provide data and classifications with our
references. References should be added
2. Background: I believe that the term "the incidence" may be used incorrectly, is
it a prevalence? Please specify
3. Results: Are "Bacterial pathogen results" are all the results of blood cultures?
Please specify
4. Results: "Ulcer stage A2" please add the reference for this classification
5. Discussion: "The third segment of the duodenum...should be taken seriously",
please reformulate
6. Abbreviations: plase correct the meaning of the abbreviation EGD, which is
correct in the text
7. Figure legends: Figure 3 Thrombosis should probably be replaced by
thrombus?
8. Tables: the presence of so many abbreviations makes it difficult to read the
tables
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant