Reviewer ’s report  
 
Title:  Bowel obstruc tion associated with a feeding jejunostomy and its association to weight loss 
after thoracoscopic esophagectomy  
 
Version: 1 Date: 25 Apr 2019 
 
Reviewer:  Tatsuo  Kanda  
 
Reviewer’s report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments ann otated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
 
GENERAL  
 
This is a retrospective study on bowel obstruction associated with feeding jejunostomy (BOFJ) 
after thoracoscopic esophagectomy. As there are few studies addressing this clinical issue, this 
reviewer read this manuscript with great interest. However, this reviewer cannot obtain any 
clinically useful information from this study and thinks that the present manuscript does not meet 
the high standards for publication in BMC Gastroenterology.  
 
 
SPECIFIC  
 
1. The authors concluded that the postoperative body weigh t (BW) loss was associated with 
BOFJ. This conclusion is unsatisfactory and clinically not useful. In this study, nutritional 
support via jejunostomy was continued after esophagectomy until the patient's oral intake 
recovered sufficiently. This can lead to  a bias in results favoring the increase in the incidence of 
high BW loss in patients with BOFJ because the occurrence of BOFJ depends on the time of 
observation after surgery. Moreover, all patients with BOFJ eventually underwent surgery, which 
seemed to have adversely affected their nutritional status. This reviewer thinks that the 
postoperative BW loss is an outcome and not a risk factor of BOFJ.   
 
2. As mentioned above, the occurrence of BOFJ depends on the time of observation after 
esophagectomy. The a uthors should indicate the observation time, that is, the median and the 
range.  
 
3. The authors should show the accumulated occurrence rate with Kaplan -Meier estimates.  
 
4. The patient's stature can be related to internal hernia associated with feeding jeju nostomy. 
Indices representing the patient's stature such as the length of the abdominal axis and the 
anatomical relationship between the navel and the site of jejunostomy should be added to the 
BOFJ -associated factors analyzed.  
 
5. The incidence of BOFJ am ong these patients seems to be rather higher than that in the general 
population. As shown in Fig. 2, the site of jejunostomy was fixed only in a small area. Did the 
authors make any sutures to prevent internal hernia in addition to the 4 sutures around th e 
insertion site of the catheter?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would yo u recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Acceptable  
 
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 tha t 
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, wri te '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  
 
I agree to the open peer review policy of the journal. I understand that my name will be include d 
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 A ccess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included 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:  Bowel obstruc tion associated with a feeding jejunostomy and its association to weight loss 
after thoracoscopic esophagectomy  
 
Version: 1 Date: 25 Apr 2019 
 
Reviewer:  Tatsuo  Kanda  
 
Reviewer’s report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments ann otated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
 
GENERAL  
 
This is a retrospective study on bowel obstruction associated with feeding jejunostomy (BOFJ) 
after thoracoscopic esophagectomy. As there are few studies addressing this clinical issue, this 
reviewer read this manuscript with great interest. However, this reviewer cannot obtain any 
clinically useful information from this study and thinks that the present manuscript does not meet 
the high standards for publication in BMC Gastroenterology.  
 
 
SPECIFIC  
 
1. The authors concluded that the postoperative body weigh t (BW) loss was associated with 
BOFJ. This conclusion is unsatisfactory and clinically not useful. In this study, nutritional 
support via jejunostomy was continued after esophagectomy until the patient's oral intake 
recovered sufficiently. This can lead to  a bias in results favoring the increase in the incidence of 
high BW loss in patients with BOFJ because the occurrence of BOFJ depends on the time of 
observation after surgery. Moreover, all patients with BOFJ eventually underwent surgery, which 
seemed to have adversely affected their nutritional status. This reviewer thinks that the 
postoperative BW loss is an outcome and not a risk factor of BOFJ.   
 
2. As mentioned above, the occurrence of BOFJ depends on the time of observation after 
esophagectomy. The a uthors should indicate the observation time, that is, the median and the 
range.  
 
3. The authors should show the accumulated occurrence rate with Kaplan -Meier estimates.  
 
4. The patient's stature can be related to internal hernia associated with feeding jeju nostomy. 
Indices representing the patient's stature such as the length of the abdominal axis and the 
anatomical relationship between the navel and the site of jejunostomy should be added to the 
BOFJ -associated factors analyzed.  
 
5. The incidence of BOFJ am ong these patients seems to be rather higher than that in the general 
population. As shown in Fig. 2, the site of jejunostomy was fixed only in a small area. Did the 
authors make any sutures to prevent internal hernia in addition to the 4 sutures around th e 
insertion site of the catheter?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would yo u recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Acceptable  
 
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 tha t 
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, wri te '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  
 
I agree to the open peer review policy of the journal. I understand that my name will be include d 
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 A ccess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included 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:  Bowel obstruc tion associated with a feeding jejunostomy and its association to weight loss 
after thoracoscopic esophagectomy  
 
Version: 1 Date: 25 Apr 2019 
 
Reviewer:  Tatsuo  Kanda  
 
Reviewer’s report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments ann otated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
 
GENERAL  
 
This is a retrospective study on bowel obstruction associated with feeding jejunostomy (BOFJ) 
after thoracoscopic esophagectomy. As there are few studies addressing this clinical issue, this 
reviewer read this manuscript with great interest. However, this reviewer cannot obtain any 
clinically useful information from this study and thinks that the present manuscript does not meet 
the high standards for publication in BMC Gastroenterology.  
 
 
SPECIFIC  
 
1. The authors concluded that the postoperative body weigh t (BW) loss was associated with 
BOFJ. This conclusion is unsatisfactory and clinically not useful. In this study, nutritional 
support via jejunostomy was continued after esophagectomy until the patient's oral intake 
recovered sufficiently. This can lead to  a bias in results favoring the increase in the incidence of 
high BW loss in patients with BOFJ because the occurrence of BOFJ depends on the time of 
observation after surgery. Moreover, all patients with BOFJ eventually underwent surgery, which 
seemed to have adversely affected their nutritional status. This reviewer thinks that the 
postoperative BW loss is an outcome and not a risk factor of BOFJ.   
 
2. As mentioned above, the occurrence of BOFJ depends on the time of observation after 
esophagectomy. The a uthors should indicate the observation time, that is, the median and the 
range.  
 
3. The authors should show the accumulated occurrence rate with Kaplan -Meier estimates.  
 
4. The patient's stature can be related to internal hernia associated with feeding jeju nostomy. 
Indices representing the patient's stature such as the length of the abdominal axis and the 
anatomical relationship between the navel and the site of jejunostomy should be added to the 
BOFJ -associated factors analyzed.  
 
5. The incidence of BOFJ am ong these patients seems to be rather higher than that in the general 
population. As shown in Fig. 2, the site of jejunostomy was fixed only in a small area. Did the 
authors make any sutures to prevent internal hernia in addition to the 4 sutures around th e 
insertion site of the catheter?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would yo u recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Acceptable  
 
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 tha t 
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, wri te '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  
 
I agree to the open peer review policy of the journal. I understand that my name will be include d 
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 A ccess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included 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