Reviewer's report
Title:Case series of Meckel's diverticulum: usefulness of double-balloon
enteroscopy for diagnosis
Version:2Date:11 June 2014
Reviewer: José Cotter
Reviewer's report:
Major Compulsory Revisions
This is an interesting and relevant case series, though requiring a few corrections
and clarification of some issues.
1- In the abstract, first paragraph (Background), there is a typing error in the word
“examination”
2- The last sentence of the Conclusion in the Abstract should be rephrased as:
“Double-balloon enteroscopy should be used complementarily to other less
invasive examinations, when needed to confirm or establish the diagnosis”
3- In the Background section, second paragraph, it should be mentioned:
“double-balloon enteroscopy (DBE) or single-balloon enteroscopy”
4- In the Case Presentation section, first paragraph, it should be referred who
performed the conscious sedation with midazolam and pentazocine
(Anaesthesiologist? Endoscopist? Nurse?)
5- In Figure 2B, the lesions should be pointed with an arrow
6- In Case 3, it should be explained the reason why DBE was performed after
nondiagnostic EGD, CS and abdominal CT, without considering other less
invasive diagnostic examinations of the small bowel previous to DBE.
7- In Case 5, it should be explained why DBE was performed, although
apparently unnecessary in view of the results of previous abdominal CT and
small bowel series.
8- In Case 6, it should be clarified whether the second retrograde DBE was
performed after bowel cleansing.
9- In the Conclusions section:
a) In the first paragraph, the first three entries mentioning “DBE” should be
complemented with “or single-balloon enteroscopy”
b) It should be emphasized the higher diagnostic yield of the retrograde approach
due to the anatomic location of most cases of MD.
c) It should be recognized that there is a limitation in the urgent setting, due to
the fact that previous bowel cleansing is required.
d) It should be highlighted that balloon enteroscopy should only be performed
after a suspected diagnosis of MD has been directly or indirectly indicated by
other less invasive diagnostic examinations, such as abdominal CT or capsule
enteroscopy ((based on bleeding or other features)
e) It should be emphasized the low sensitivity of Tc-99m pertechnetate
scintigraphy for the diagnosis of MD in this case series.
10- Finally, it would be interesting and very enriching in terms of assessing the
real value of DBE in the diagnosis of MD, to know the number of patients with
MD treated during the same period in the Kobe City Medical Center General
Hospital who did not require DBE for the diagnosis.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Case series of Meckel's diverticulum: usefulness of double-balloon
enteroscopy for diagnosis
Version:2Date:11 June 2014
Reviewer: José Cotter
Reviewer's report:
Major Compulsory Revisions
This is an interesting and relevant case series, though requiring a few corrections
and clarification of some issues.
1- In the abstract, first paragraph (Background), there is a typing error in the word
“examination”
2- The last sentence of the Conclusion in the Abstract should be rephrased as:
“Double-balloon enteroscopy should be used complementarily to other less
invasive examinations, when needed to confirm or establish the diagnosis”
3- In the Background section, second paragraph, it should be mentioned:
“double-balloon enteroscopy (DBE) or single-balloon enteroscopy”
4- In the Case Presentation section, first paragraph, it should be referred who
performed the conscious sedation with midazolam and pentazocine
(Anaesthesiologist? Endoscopist? Nurse?)
5- In Figure 2B, the lesions should be pointed with an arrow
6- In Case 3, it should be explained the reason why DBE was performed after
nondiagnostic EGD, CS and abdominal CT, without considering other less
invasive diagnostic examinations of the small bowel previous to DBE.
7- In Case 5, it should be explained why DBE was performed, although
apparently unnecessary in view of the results of previous abdominal CT and
small bowel series.
8- In Case 6, it should be clarified whether the second retrograde DBE was
performed after bowel cleansing.
9- In the Conclusions section:
a) In the first paragraph, the first three entries mentioning “DBE” should be
complemented with “or single-balloon enteroscopy”
b) It should be emphasized the higher diagnostic yield of the retrograde approach
due to the anatomic location of most cases of MD.
c) It should be recognized that there is a limitation in the urgent setting, due to
the fact that previous bowel cleansing is required.
d) It should be highlighted that balloon enteroscopy should only be performed
after a suspected diagnosis of MD has been directly or indirectly indicated by
other less invasive diagnostic examinations, such as abdominal CT or capsule
enteroscopy ((based on bleeding or other features)
e) It should be emphasized the low sensitivity of Tc-99m pertechnetate
scintigraphy for the diagnosis of MD in this case series.
10- Finally, it would be interesting and very enriching in terms of assessing the
real value of DBE in the diagnosis of MD, to know the number of patients with
MD treated during the same period in the Kobe City Medical Center General
Hospital who did not require DBE for the diagnosis.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Case series of Meckel's diverticulum: usefulness of double-balloon
enteroscopy for diagnosis
Version:2Date:11 June 2014
Reviewer: José Cotter
Reviewer's report:
Major Compulsory Revisions
This is an interesting and relevant case series, though requiring a few corrections
and clarification of some issues.
1- In the abstract, first paragraph (Background), there is a typing error in the word
“examination”
2- The last sentence of the Conclusion in the Abstract should be rephrased as:
“Double-balloon enteroscopy should be used complementarily to other less
invasive examinations, when needed to confirm or establish the diagnosis”
3- In the Background section, second paragraph, it should be mentioned:
“double-balloon enteroscopy (DBE) or single-balloon enteroscopy”
4- In the Case Presentation section, first paragraph, it should be referred who
performed the conscious sedation with midazolam and pentazocine
(Anaesthesiologist? Endoscopist? Nurse?)
5- In Figure 2B, the lesions should be pointed with an arrow
6- In Case 3, it should be explained the reason why DBE was performed after
nondiagnostic EGD, CS and abdominal CT, without considering other less
invasive diagnostic examinations of the small bowel previous to DBE.
7- In Case 5, it should be explained why DBE was performed, although
apparently unnecessary in view of the results of previous abdominal CT and
small bowel series.
8- In Case 6, it should be clarified whether the second retrograde DBE was
performed after bowel cleansing.
9- In the Conclusions section:
a) In the first paragraph, the first three entries mentioning “DBE” should be
complemented with “or single-balloon enteroscopy”
b) It should be emphasized the higher diagnostic yield of the retrograde approach
due to the anatomic location of most cases of MD.
c) It should be recognized that there is a limitation in the urgent setting, due to
the fact that previous bowel cleansing is required.
d) It should be highlighted that balloon enteroscopy should only be performed
after a suspected diagnosis of MD has been directly or indirectly indicated by
other less invasive diagnostic examinations, such as abdominal CT or capsule
enteroscopy ((based on bleeding or other features)
e) It should be emphasized the low sensitivity of Tc-99m pertechnetate
scintigraphy for the diagnosis of MD in this case series.
10- Finally, it would be interesting and very enriching in terms of assessing the
real value of DBE in the diagnosis of MD, to know the number of patients with
MD treated during the same period in the Kobe City Medical Center General
Hospital who did not require DBE for the diagnosis.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
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