Reviewer’s report
Title: 
Segmental reversal of the distal small intestine in a short bowel syndrome
model in piglets showed detrimental effect on weight gain
Version: 
1 
Date: 
11 Mar 2022
Reviewer's report:
Dear authors,
Thank you for your manuscript. This is a well-conducted study and a well-
written manuscript. I believe this paper is suited for publication after some
revisions and I have following comments for you:
1. Methods: Why did you choose to resect 70% of the bowel? It was previously
shown that 75% intestinal resection is less suitable as an SBS model, as animals
tend to recover remarkably (check and cite PMID: 26375577 and PMID:
24081112). As a short-term animal model the 70% bowel resection could be not
optimal to test investigate the effects of a reversed segment of the distal small
intestine to improve weight gain. The provided concerns of the local Animal
Experiments Inspector to remove more than 70 % of the small intestine in
present study is opposed to literature. Please discuss this. 
2. Methods: Why did you chose to reverse the distal 25 cm of the remnant
jejunum, why not shorter or longer and why at this part of the bowel? Is this
length and location adequate for your purpose, please discuss and possibly
provide the available literature at the section you state: "Reversal of a 25 cm
segment was chosen taking the available literature". This seems important as you
report "The findings with lower villus height, lesser crypt depth and lower GIP-
levels in the intervention group might indicate, that the reversed segment was too
extensive, and may have caused subileus with related histological changes." but,
as you cite "Grave et al.(21) found no significant difference in weight by
reversing 20 cm in an almost identical SBS model"
3. Methods: Every pig potentially has different bowel length. By resecting 70%
of the present bowel potentially leads to different remnant intestinal lengths from
pig to pig. This might bias the evaluation. A possible optimized approach could
have been to leave an equal length of bowel in each pig in order to standardize
the SBS model (check and cite PMID: 26375577). Please discuss this point as a
limitation of your study. 
4. Results: You report: "No significant difference in GLP-2 and GIP-levels was
found in the intervention group measured at day 0 and day 28, whereas levels for
both hormones increased significantly in the control group. GIP-levels were
significantly lower in the intervention group at day 28, compared with the
control-group at day 28. (Fig2)." And provide a visually helpful figure 2. Could
you discuss how GLP-2 and GIP changes can be explained?
5. Discussion: Please discuss more in depth the implications of your results for
the daily routine are and which other surgical alternatives are available (check
and cite PMID: 23932625, PMID: 24074666 PMID: 26220675, PMID:
27086890, PMID: 30471736 and similar articles). 
Publons Reviewer Recognition
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find the details of processing in Publons’ privacy policy
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No
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?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Segmental reversal of the distal small intestine in a short bowel syndrome
model in piglets showed detrimental effect on weight gain
Version: 
1 
Date: 
11 Mar 2022
Reviewer's report:
Dear authors,
Thank you for your manuscript. This is a well-conducted study and a well-
written manuscript. I believe this paper is suited for publication after some
revisions and I have following comments for you:
1. Methods: Why did you choose to resect 70% of the bowel? It was previously
shown that 75% intestinal resection is less suitable as an SBS model, as animals
tend to recover remarkably (check and cite PMID: 26375577 and PMID:
24081112). As a short-term animal model the 70% bowel resection could be not
optimal to test investigate the effects of a reversed segment of the distal small
intestine to improve weight gain. The provided concerns of the local Animal
Experiments Inspector to remove more than 70 % of the small intestine in
present study is opposed to literature. Please discuss this. 
2. Methods: Why did you chose to reverse the distal 25 cm of the remnant
jejunum, why not shorter or longer and why at this part of the bowel? Is this
length and location adequate for your purpose, please discuss and possibly
provide the available literature at the section you state: "Reversal of a 25 cm
segment was chosen taking the available literature". This seems important as you
report "The findings with lower villus height, lesser crypt depth and lower GIP-
levels in the intervention group might indicate, that the reversed segment was too
extensive, and may have caused subileus with related histological changes." but,
as you cite "Grave et al.(21) found no significant difference in weight by
reversing 20 cm in an almost identical SBS model"
3. Methods: Every pig potentially has different bowel length. By resecting 70%
of the present bowel potentially leads to different remnant intestinal lengths from
pig to pig. This might bias the evaluation. A possible optimized approach could
have been to leave an equal length of bowel in each pig in order to standardize
the SBS model (check and cite PMID: 26375577). Please discuss this point as a
limitation of your study. 
4. Results: You report: "No significant difference in GLP-2 and GIP-levels was
found in the intervention group measured at day 0 and day 28, whereas levels for
both hormones increased significantly in the control group. GIP-levels were
significantly lower in the intervention group at day 28, compared with the
control-group at day 28. (Fig2)." And provide a visually helpful figure 2. Could
you discuss how GLP-2 and GIP changes can be explained?
5. Discussion: Please discuss more in depth the implications of your results for
the daily routine are and which other surgical alternatives are available (check
and cite PMID: 23932625, PMID: 24074666 PMID: 26220675, PMID:
27086890, PMID: 30471736 and similar articles). 
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 after the final decision on the manuscript has been made. 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
No
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?
Yes
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: 
Segmental reversal of the distal small intestine in a short bowel syndrome
model in piglets showed detrimental effect on weight gain
Version: 
1 
Date: 
11 Mar 2022
Reviewer's report:
Dear authors,
Thank you for your manuscript. This is a well-conducted study and a well-
written manuscript. I believe this paper is suited for publication after some
revisions and I have following comments for you:
1. Methods: Why did you choose to resect 70% of the bowel? It was previously
shown that 75% intestinal resection is less suitable as an SBS model, as animals
tend to recover remarkably (check and cite PMID: 26375577 and PMID:
24081112). As a short-term animal model the 70% bowel resection could be not
optimal to test investigate the effects of a reversed segment of the distal small
intestine to improve weight gain. The provided concerns of the local Animal
Experiments Inspector to remove more than 70 % of the small intestine in
present study is opposed to literature. Please discuss this. 
2. Methods: Why did you chose to reverse the distal 25 cm of the remnant
jejunum, why not shorter or longer and why at this part of the bowel? Is this
length and location adequate for your purpose, please discuss and possibly
provide the available literature at the section you state: "Reversal of a 25 cm
segment was chosen taking the available literature". This seems important as you
report "The findings with lower villus height, lesser crypt depth and lower GIP-
levels in the intervention group might indicate, that the reversed segment was too
extensive, and may have caused subileus with related histological changes." but,
as you cite "Grave et al.(21) found no significant difference in weight by
reversing 20 cm in an almost identical SBS model"
3. Methods: Every pig potentially has different bowel length. By resecting 70%
of the present bowel potentially leads to different remnant intestinal lengths from
pig to pig. This might bias the evaluation. A possible optimized approach could
have been to leave an equal length of bowel in each pig in order to standardize
the SBS model (check and cite PMID: 26375577). Please discuss this point as a
limitation of your study. 
4. Results: You report: "No significant difference in GLP-2 and GIP-levels was
found in the intervention group measured at day 0 and day 28, whereas levels for
both hormones increased significantly in the control group. GIP-levels were
significantly lower in the intervention group at day 28, compared with the
control-group at day 28. (Fig2)." And provide a visually helpful figure 2. Could
you discuss how GLP-2 and GIP changes can be explained?
5. Discussion: Please discuss more in depth the implications of your results for
the daily routine are and which other surgical alternatives are available (check
and cite PMID: 23932625, PMID: 24074666 PMID: 26220675, PMID:
27086890, PMID: 30471736 and similar articles). 
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 after the final decision on the manuscript has been made. 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
No
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?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant