Title: Non-Foreign Body-Associated Risk Factors for Complications Associated with
Esophageal Foreign-Body Removal and Timing of Endoscopic Treatment: A Single-Center
Retrospective Study
Version: 1 Date: 03 Sep 2024
Reviewer:  Kengo Kasuga
Reviewer's report:
The authors have investigated the risk factors for complications associated with esophageal
foreign body removal. It is important to perform a preliminary clinical risk assessment of
complications.
I think some descriptions were questionable. Below is my specific critics.
1. In Materials and Methods, the definitions of holiday and COVID19 epidemic period should
be included. In addition, any specific changes in clinical behavior or changes in hospital rules
during the COVID19 and non-COVID19 periods should be explained.
2. In Supplementary Table 1, the authors state that foreign bodies are often the sharp bones of
fish and birds. Fish bones are known to cause gastrointestinal perforation, often in the small
intestine or bile duct, even after passing through the esophagus. If pushing a foreign body into the
stomach is considered a technical success, there should be an investigation into the probability
of this and whether the patient was successfully discharged.
3. I am doing multivariate analysis with mucosal injury, mucosal bleeding, and mucosal
perforation, however, I consider perforation and technical failure to be the clinically important
factors. It would be more useful information if risk factors for technical failure were also
examined.
4. The authors report that perforation occurred in 6.9% of cases. If the risk of complications is
to be discussed, it is necessary to separate cases in which the endoscopic procedure caused the
perforation from those in which the perforation was known to have occurred on prior CT scan.
5. Endoscopic findings are a subjective factor and there is a problem of interexamination
agreement. The author needs to elaborate on what methods were used to retrospectively examine
the patient. (i.e., was the physician reviewing the images an endoscopist, was it one doctor, was
it multiple doctors, did they have extensive endoscopic experience, etc.)
Title: Non-Foreign Body-Associated Risk Factors for Complications Associated with
Esophageal Foreign-Body Removal and Timing of Endoscopic Treatment: A Single-Center
Retrospective Study
Version: 1 Date: 03 Sep 2024
Reviewer:  Kengo Kasuga
Reviewer's report:
The authors have investigated the risk factors for complications associated with esophageal
foreign body removal. It is important to perform a preliminary clinical risk assessment of
complications.
I think some descriptions were questionable. Below is my specific critics.
1. In Materials and Methods, the definitions of holiday and COVID19 epidemic period should
be included. In addition, any specific changes in clinical behavior or changes in hospital rules
during the COVID19 and non-COVID19 periods should be explained.
2. In Supplementary Table 1, the authors state that foreign bodies are often the sharp bones of
fish and birds. Fish bones are known to cause gastrointestinal perforation, often in the small
intestine or bile duct, even after passing through the esophagus. If pushing a foreign body into the
stomach is considered a technical success, there should be an investigation into the probability
of this and whether the patient was successfully discharged.
3. I am doing multivariate analysis with mucosal injury, mucosal bleeding, and mucosal
perforation, however, I consider perforation and technical failure to be the clinically important
factors. It would be more useful information if risk factors for technical failure were also
examined.
4. The authors report that perforation occurred in 6.9% of cases. If the risk of complications is
to be discussed, it is necessary to separate cases in which the endoscopic procedure caused the
perforation from those in which the perforation was known to have occurred on prior CT scan.
5. Endoscopic findings are a subjective factor and there is a problem of interexamination
agreement. The author needs to elaborate on what methods were used to retrospectively examine
the patient. (i.e., was the physician reviewing the images an endoscopist, was it one doctor, was
it multiple doctors, did they have extensive endoscopic experience, etc.)
Please review this paper.
user
Title: Non-Foreign Body-Associated Risk Factors for Complications Associated with
Esophageal Foreign-Body Removal and Timing of Endoscopic Treatment: A Single-Center
Retrospective Study
Version: 1 Date: 03 Sep 2024
Reviewer:  Kengo Kasuga
Reviewer's report:
The authors have investigated the risk factors for complications associated with esophageal
foreign body removal. It is important to perform a preliminary clinical risk assessment of
complications.
I think some descriptions were questionable. Below is my specific critics.
1. In Materials and Methods, the definitions of holiday and COVID19 epidemic period should
be included. In addition, any specific changes in clinical behavior or changes in hospital rules
during the COVID19 and non-COVID19 periods should be explained.
2. In Supplementary Table 1, the authors state that foreign bodies are often the sharp bones of
fish and birds. Fish bones are known to cause gastrointestinal perforation, often in the small
intestine or bile duct, even after passing through the esophagus. If pushing a foreign body into the
stomach is considered a technical success, there should be an investigation into the probability
of this and whether the patient was successfully discharged.
3. I am doing multivariate analysis with mucosal injury, mucosal bleeding, and mucosal
perforation, however, I consider perforation and technical failure to be the clinically important
factors. It would be more useful information if risk factors for technical failure were also
examined.
4. The authors report that perforation occurred in 6.9% of cases. If the risk of complications is
to be discussed, it is necessary to separate cases in which the endoscopic procedure caused the
perforation from those in which the perforation was known to have occurred on prior CT scan.
5. Endoscopic findings are a subjective factor and there is a problem of interexamination
agreement. The author needs to elaborate on what methods were used to retrospectively examine
the patient. (i.e., was the physician reviewing the images an endoscopist, was it one doctor, was
it multiple doctors, did they have extensive endoscopic experience, etc.)
assistant