Reviewer ’s report  
Title: Recurrent esophageal stricture from previous caustic ingestion tre ated with 40 -year 
selfdilation: case report and review of literature  
 
Version: 1 Date: 14 Dec 2016  
 
Reviewer: Harkirat Si ngh 
 
Reviewer's report:  
This looks better than the original but still significant improvement is needed in english. A few 
other points are mentioned below.  
 
In abstract:  
1. Correct spellings of "background".  
2. Would remove "and dangerous events".  
3. "severity of the lesions", change lesions to strictures.  
4. Endoscopic therapy is not cornerstone of prevention? Can you give data where it is used 
routinely for prevention?  
5. Delete " for suicidal purpose".  
6. Rewrite "the procedure carried out for  the longer….."  
 
Introduction:  
1. "Acids ingestion cause a coaugulative necrosis: - Correct spellings - coagulative  
2. "On the other hand, alkali ingestion  
produce liquefactive necrosis generating proteinates and soap, leading to a full thickness lesions" 
- Correct grammatical errors  
3. "The most important step in the  
management of caustic injuries is the prevention of esophageal strictures" - Not sure this is the 
most important step. Hemodynamic stability, treatment of acute things is most important. Pleas e 
rephrase this or delete.  
4. "Steroids,  
insertion of nasogastric tube, antibiotics and early esophagea l dilatation are among the most 
important therapeutic weapons to reduce the risk of a severe esophageal stenosis [1]." Steroids 
are not routinely used. C onsider rephrasing. Also may not need to talk about this. Can just talk 
acute complications, need for EGD within 24 hrs if no significant contraindication and then talk 
about stenosis as most important chronic complication. So, consider deleting "Due to th e 
recurrent stenosis, sometimes even after radical surgery, balloon dilatation or endoscopic 
bougienage are often necessary but also expensive and invasive procedures."  
 
5. "Her ein, we d escribe a rare case of esophageal self -dilatation after caustic soda i ngestion 
by the use of Maloney bougie for the duration of about 40 years. Using the keywords 
"esophageal self -dilation", "self -bougienage", "caustic ingestion", "benign esophageal stenosis", 
a PubMed database search (PubMed, National Library of Medicine, B ethesda, MD, United 
States) and a Literature review were performed demonstrating the rarity of the presented case 
and the efficacy of clinical method." Can just say what case you are presenting and review of 
literature.  
 
Case presentation:  
1. "At one year  from the ingestion, she autonomously bought a Maloney dilator of 5mm of 
calibre, and started periodically self -dilatations after an adequate training consisting of viewing 
the self -dilation teaching -video, undergoing physician -performed endoscopic dilatio n and  
participating in three self -dilation practice sessions supervised by a physician according to the 
technique described by Dzeletovic"  
 
Are you sure she was shown video 60 years ago?  
 
2. "The periodical self -dilations a nd semi -liquid nutrition led to a great improve of her 
nutritional status" . Change improve to improvement.  
 
3. "A stenosis of the medium and lower" - middle and lower  
 
 
Discussion:  
1. "The  
prevalence of esophageal stenosis is 129 and 122 per 100.000, for men and woman respectively" 
- This isn't from caustic ingestion. It appears while reading that you're talking about prevalence 
of caustic ingestion induced esophageal strictures.  
 
2. "Endoscopy within the first 24 hours has a paramount importance in the management of 
the acute  
and life -threatening complications"  
 
Again, EGD is performed within 1st 24 hrs to see extent of injury and making treatment 
decisions like conservative vs surgery. Please rephrase the sentence. It sounds like we do EGD 
for endoscopic management of acute/life threat ening complications.  
 
3. Perforation can present with chest pain, abdominal rigidi ty, fever, shortness of breath, 
effusion or sepsis while bleeding is generally self -limited, even significant and persistent 
haemorrhage has been reported in patients with es ophageal varices.  
 
Can consider deleting this line.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments  to the authors.  
Unable to assess  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical revi ew? 
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
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  
organisati on that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscrip t, 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 compet ing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted  on the website along with the authors' 
responses. 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/ ). I understand that any comments 
which I do not wish to be includ ed in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
Title: Recurrent esophageal stricture from previous caustic ingestion tre ated with 40 -year 
selfdilation: case report and review of literature  
 
Version: 1 Date: 14 Dec 2016  
 
Reviewer: Harkirat Si ngh 
 
Reviewer's report:  
This looks better than the original but still significant improvement is needed in english. A few 
other points are mentioned below.  
 
In abstract:  
1. Correct spellings of "background".  
2. Would remove "and dangerous events".  
3. "severity of the lesions", change lesions to strictures.  
4. Endoscopic therapy is not cornerstone of prevention? Can you give data where it is used 
routinely for prevention?  
5. Delete " for suicidal purpose".  
6. Rewrite "the procedure carried out for  the longer….."  
 
Introduction:  
1. "Acids ingestion cause a coaugulative necrosis: - Correct spellings - coagulative  
2. "On the other hand, alkali ingestion  
produce liquefactive necrosis generating proteinates and soap, leading to a full thickness lesions" 
- Correct grammatical errors  
3. "The most important step in the  
management of caustic injuries is the prevention of esophageal strictures" - Not sure this is the 
most important step. Hemodynamic stability, treatment of acute things is most important. Pleas e 
rephrase this or delete.  
4. "Steroids,  
insertion of nasogastric tube, antibiotics and early esophagea l dilatation are among the most 
important therapeutic weapons to reduce the risk of a severe esophageal stenosis [1]." Steroids 
are not routinely used. C onsider rephrasing. Also may not need to talk about this. Can just talk 
acute complications, need for EGD within 24 hrs if no significant contraindication and then talk 
about stenosis as most important chronic complication. So, consider deleting "Due to th e 
recurrent stenosis, sometimes even after radical surgery, balloon dilatation or endoscopic 
bougienage are often necessary but also expensive and invasive procedures."  
 
5. "Her ein, we d escribe a rare case of esophageal self -dilatation after caustic soda i ngestion 
by the use of Maloney bougie for the duration of about 40 years. Using the keywords 
"esophageal self -dilation", "self -bougienage", "caustic ingestion", "benign esophageal stenosis", 
a PubMed database search (PubMed, National Library of Medicine, B ethesda, MD, United 
States) and a Literature review were performed demonstrating the rarity of the presented case 
and the efficacy of clinical method." Can just say what case you are presenting and review of 
literature.  
 
Case presentation:  
1. "At one year  from the ingestion, she autonomously bought a Maloney dilator of 5mm of 
calibre, and started periodically self -dilatations after an adequate training consisting of viewing 
the self -dilation teaching -video, undergoing physician -performed endoscopic dilatio n and  
participating in three self -dilation practice sessions supervised by a physician according to the 
technique described by Dzeletovic"  
 
Are you sure she was shown video 60 years ago?  
 
2. "The periodical self -dilations a nd semi -liquid nutrition led to a great improve of her 
nutritional status" . Change improve to improvement.  
 
3. "A stenosis of the medium and lower" - middle and lower  
 
 
Discussion:  
1. "The  
prevalence of esophageal stenosis is 129 and 122 per 100.000, for men and woman respectively" 
- This isn't from caustic ingestion. It appears while reading that you're talking about prevalence 
of caustic ingestion induced esophageal strictures.  
 
2. "Endoscopy within the first 24 hours has a paramount importance in the management of 
the acute  
and life -threatening complications"  
 
Again, EGD is performed within 1st 24 hrs to see extent of injury and making treatment 
decisions like conservative vs surgery. Please rephrase the sentence. It sounds like we do EGD 
for endoscopic management of acute/life threat ening complications.  
 
3. Perforation can present with chest pain, abdominal rigidi ty, fever, shortness of breath, 
effusion or sepsis while bleeding is generally self -limited, even significant and persistent 
haemorrhage has been reported in patients with es ophageal varices.  
 
Can consider deleting this line.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments  to the authors.  
Unable to assess  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical revi ew? 
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
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  
organisati on that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscrip t, 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 compet ing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted  on the website along with the authors' 
responses. 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/ ). I understand that any comments 
which I do not wish to be includ ed in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
Title: Recurrent esophageal stricture from previous caustic ingestion tre ated with 40 -year 
selfdilation: case report and review of literature  
 
Version: 1 Date: 14 Dec 2016  
 
Reviewer: Harkirat Si ngh 
 
Reviewer's report:  
This looks better than the original but still significant improvement is needed in english. A few 
other points are mentioned below.  
 
In abstract:  
1. Correct spellings of "background".  
2. Would remove "and dangerous events".  
3. "severity of the lesions", change lesions to strictures.  
4. Endoscopic therapy is not cornerstone of prevention? Can you give data where it is used 
routinely for prevention?  
5. Delete " for suicidal purpose".  
6. Rewrite "the procedure carried out for  the longer….."  
 
Introduction:  
1. "Acids ingestion cause a coaugulative necrosis: - Correct spellings - coagulative  
2. "On the other hand, alkali ingestion  
produce liquefactive necrosis generating proteinates and soap, leading to a full thickness lesions" 
- Correct grammatical errors  
3. "The most important step in the  
management of caustic injuries is the prevention of esophageal strictures" - Not sure this is the 
most important step. Hemodynamic stability, treatment of acute things is most important. Pleas e 
rephrase this or delete.  
4. "Steroids,  
insertion of nasogastric tube, antibiotics and early esophagea l dilatation are among the most 
important therapeutic weapons to reduce the risk of a severe esophageal stenosis [1]." Steroids 
are not routinely used. C onsider rephrasing. Also may not need to talk about this. Can just talk 
acute complications, need for EGD within 24 hrs if no significant contraindication and then talk 
about stenosis as most important chronic complication. So, consider deleting "Due to th e 
recurrent stenosis, sometimes even after radical surgery, balloon dilatation or endoscopic 
bougienage are often necessary but also expensive and invasive procedures."  
 
5. "Her ein, we d escribe a rare case of esophageal self -dilatation after caustic soda i ngestion 
by the use of Maloney bougie for the duration of about 40 years. Using the keywords 
"esophageal self -dilation", "self -bougienage", "caustic ingestion", "benign esophageal stenosis", 
a PubMed database search (PubMed, National Library of Medicine, B ethesda, MD, United 
States) and a Literature review were performed demonstrating the rarity of the presented case 
and the efficacy of clinical method." Can just say what case you are presenting and review of 
literature.  
 
Case presentation:  
1. "At one year  from the ingestion, she autonomously bought a Maloney dilator of 5mm of 
calibre, and started periodically self -dilatations after an adequate training consisting of viewing 
the self -dilation teaching -video, undergoing physician -performed endoscopic dilatio n and  
participating in three self -dilation practice sessions supervised by a physician according to the 
technique described by Dzeletovic"  
 
Are you sure she was shown video 60 years ago?  
 
2. "The periodical self -dilations a nd semi -liquid nutrition led to a great improve of her 
nutritional status" . Change improve to improvement.  
 
3. "A stenosis of the medium and lower" - middle and lower  
 
 
Discussion:  
1. "The  
prevalence of esophageal stenosis is 129 and 122 per 100.000, for men and woman respectively" 
- This isn't from caustic ingestion. It appears while reading that you're talking about prevalence 
of caustic ingestion induced esophageal strictures.  
 
2. "Endoscopy within the first 24 hours has a paramount importance in the management of 
the acute  
and life -threatening complications"  
 
Again, EGD is performed within 1st 24 hrs to see extent of injury and making treatment 
decisions like conservative vs surgery. Please rephrase the sentence. It sounds like we do EGD 
for endoscopic management of acute/life threat ening complications.  
 
3. Perforation can present with chest pain, abdominal rigidi ty, fever, shortness of breath, 
effusion or sepsis while bleeding is generally self -limited, even significant and persistent 
haemorrhage has been reported in patients with es ophageal varices.  
 
Can consider deleting this line.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments  to the authors.  
Unable to assess  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical revi ew? 
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
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  
organisati on that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscrip t, 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 compet ing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted  on the website along with the authors' 
responses. 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/ ). I understand that any comments 
which I do not wish to be includ ed in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant