Reviewer ’s report  
 
Title: Colonic transendoscopic tube -delivered enteral therapy (with video): A prospective study  
 
Version: 0 Date: 24 Oct 2019  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other  article types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
Yes - the approach is appropriate  
 
 
EXECUTION - Are the experiments an d analyses performed with technical rigor to allow 
confidence in the results?  
 
No - there are minor issues  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
N/A - there are no statistics in this study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
No - there are minor issues  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make  the work technically sound?  
 
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS:  
 
Overall Impression  
 
 This paper describes experience with a colonoscopiec transendoscopic  delivery system of fecal 
cultures or other active  agents t hat allows direct intraconoc lumenal delivery. The interesting 
part is a system for repeated delivery over a week to several weeks. This is novel methodology 
and may proved very useful in  selected mucosal diseases of the colon. Note that this study 
evalua tes only the methodology of placement of the  transanal catheter for drug delivery and the 
patient tolerance of such an indwelling transanal catheter  
  
 
What have the authors done well  
 
 The authors have described and evaluated a methodology for direct and r epeated intrude 
although delivery of active agents. It needs work on the grammar and word usage but the system 
is well described   
  
 
In what ways does it not meet best practice  
 
 I think that the authors have done a good job at following usual procedures f or an 
observational/prospective  study. The methodology of determining true "patient satisfaction" is 
not tight or well described but the overall big picture is OK.    
 
 
REQUESTED REVISIONS:  
 
Are there additional revisions the authors should make -consider  
 
 1. Would change the phrase "colonic trans - endoscopic tube" to "colonic transendoscopic enteral 
delivery system (CTEDS) which makes much more  sense or to colonic (TEDS)  
 
  2. Lines 27 -29. Here I would suggest that you very briefly describe the fact that  you left the 
delivery catheter within the colon for up to X days (X being the maximum number of days in any 
of the patients)  exiting from the anus  
 
3. Line 34 no one will understand the "titanium clip type" phrase. This needs to be added to the 
methods s ection explaining how and where in colon and on tube the clips were placed  
 
4. Line 52 the phrase "in current (14) or ancient (15)" needs to be replace as written it makes no 
sense  
 
5. Line 60 do you really mean that a patient suffocates? I doubt it!   change the word suffocation 
to something more reasonable? Difficulty breathing, episodes of difficulty breathing , or 
something like that -- I am not certain what you mean by suffocation  
 
6. Line 65. Reword " special structure of the colon" don't you really mean "due to the more distal 
anatomic location of the colon in the gastrointestinal tract and the difficulty delivering the agent 
directly into the colonic lumen"?  
 
7. line 73 reword as "by the long term maintenance of an indwelling, colonoscopically  place d  
transanal catheter  
 
8. Line 86 please round off the 98.1% to a whole number  
 
9. Line 87 and everywhere else in the text -change to "retention time"  
 
10. Line 117. Is the parafin oil used to facilitate removal of the colonoscope over the colonic 
catheter? I f so explain it  
 
11. Line 108 on you need to do a better job describing both the tube( I would change this term to 
catheter) and the technique  of  fixation because the photo does not do it justice, and requiring 
the reader to look at your previous publicat ions is not appropriate. Explain how the clip is fixed 
to the catheter . Also is the catheter made by a company? What is the catheter made from? 
Silicone? Plastic? etc. If so, which company and what is it called in case others want to try to 
obtain such a tube.  Also when describing its initial insertion , inform the reader that there is a 
guide wire within the catheter initially  
 
12. Reword the phrase " line loop" do you mean a markings are placed at 10cm distances from 
the end of the catheter?  
 
13. Is the g uide wire left in while removing the colonoscope over the catheter?  
 
14. Line 160 did the 107 patients only have a one time delivery of medication and the catheter 
was not left in place afterwards? if so say "107 (47.8%) had a one time delivery of FMT" nd t he 
catheter was removed  
 
15 lines 169 - 170. How long did you want the catheter to remain in the colonic lumen?  
 
16. Line 199 reword to " for several types of mucosal diseases of the colon such as ulcerative 
colitis.  
 
17 you use the phrase TET tube. Which when  written out without the abbreviation would be 
transendoscopic enteral tubing  tube" not good  
 
See #1 above  
  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
see above my comprehensive suggestions, but note the text will require some heavy editing if the 
journal does n ot do this then use of a scientific editing service like Accdon (which focuses on 
Chinese submissions)  or Nature editing  or Springer editing will be necessary  
 
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.  
 
No 
 
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  manus cript or would you recommend an 
additional statistical review?  
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 writ ten 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, f ees, funding, or salary 
from an organisation 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 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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution Lic ense 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or 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 included in my named report can be included as confidential comme nts 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Colonic transendoscopic tube -delivered enteral therapy (with video): A prospective study  
 
Version: 0 Date: 24 Oct 2019  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other  article types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
Yes - the approach is appropriate  
 
 
EXECUTION - Are the experiments an d analyses performed with technical rigor to allow 
confidence in the results?  
 
No - there are minor issues  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
N/A - there are no statistics in this study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
No - there are minor issues  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make  the work technically sound?  
 
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS:  
 
Overall Impression  
 
 This paper describes experience with a colonoscopiec transendoscopic  delivery system of fecal 
cultures or other active  agents t hat allows direct intraconoc lumenal delivery. The interesting 
part is a system for repeated delivery over a week to several weeks. This is novel methodology 
and may proved very useful in  selected mucosal diseases of the colon. Note that this study 
evalua tes only the methodology of placement of the  transanal catheter for drug delivery and the 
patient tolerance of such an indwelling transanal catheter  
  
 
What have the authors done well  
 
 The authors have described and evaluated a methodology for direct and r epeated intrude 
although delivery of active agents. It needs work on the grammar and word usage but the system 
is well described   
  
 
In what ways does it not meet best practice  
 
 I think that the authors have done a good job at following usual procedures f or an 
observational/prospective  study. The methodology of determining true "patient satisfaction" is 
not tight or well described but the overall big picture is OK.    
 
 
REQUESTED REVISIONS:  
 
Are there additional revisions the authors should make -consider  
 
 1. Would change the phrase "colonic trans - endoscopic tube" to "colonic transendoscopic enteral 
delivery system (CTEDS) which makes much more  sense or to colonic (TEDS)  
 
  2. Lines 27 -29. Here I would suggest that you very briefly describe the fact that  you left the 
delivery catheter within the colon for up to X days (X being the maximum number of days in any 
of the patients)  exiting from the anus  
 
3. Line 34 no one will understand the "titanium clip type" phrase. This needs to be added to the 
methods s ection explaining how and where in colon and on tube the clips were placed  
 
4. Line 52 the phrase "in current (14) or ancient (15)" needs to be replace as written it makes no 
sense  
 
5. Line 60 do you really mean that a patient suffocates? I doubt it!   change the word suffocation 
to something more reasonable? Difficulty breathing, episodes of difficulty breathing , or 
something like that -- I am not certain what you mean by suffocation  
 
6. Line 65. Reword " special structure of the colon" don't you really mean "due to the more distal 
anatomic location of the colon in the gastrointestinal tract and the difficulty delivering the agent 
directly into the colonic lumen"?  
 
7. line 73 reword as "by the long term maintenance of an indwelling, colonoscopically  place d  
transanal catheter  
 
8. Line 86 please round off the 98.1% to a whole number  
 
9. Line 87 and everywhere else in the text -change to "retention time"  
 
10. Line 117. Is the parafin oil used to facilitate removal of the colonoscope over the colonic 
catheter? I f so explain it  
 
11. Line 108 on you need to do a better job describing both the tube( I would change this term to 
catheter) and the technique  of  fixation because the photo does not do it justice, and requiring 
the reader to look at your previous publicat ions is not appropriate. Explain how the clip is fixed 
to the catheter . Also is the catheter made by a company? What is the catheter made from? 
Silicone? Plastic? etc. If so, which company and what is it called in case others want to try to 
obtain such a tube.  Also when describing its initial insertion , inform the reader that there is a 
guide wire within the catheter initially  
 
12. Reword the phrase " line loop" do you mean a markings are placed at 10cm distances from 
the end of the catheter?  
 
13. Is the g uide wire left in while removing the colonoscope over the catheter?  
 
14. Line 160 did the 107 patients only have a one time delivery of medication and the catheter 
was not left in place afterwards? if so say "107 (47.8%) had a one time delivery of FMT" nd t he 
catheter was removed  
 
15 lines 169 - 170. How long did you want the catheter to remain in the colonic lumen?  
 
16. Line 199 reword to " for several types of mucosal diseases of the colon such as ulcerative 
colitis.  
 
17 you use the phrase TET tube. Which when  written out without the abbreviation would be 
transendoscopic enteral tubing  tube" not good  
 
See #1 above  
  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
see above my comprehensive suggestions, but note the text will require some heavy editing if the 
journal does n ot do this then use of a scientific editing service like Accdon (which focuses on 
Chinese submissions)  or Nature editing  or Springer editing will be necessary  
 
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.  
 
No 
 
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  manus cript or would you recommend an 
additional statistical review?  
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 writ ten 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, f ees, funding, or salary 
from an organisation 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 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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution Lic ense 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or 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 included in my named report can be included as confidential comme nts 
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: Colonic transendoscopic tube -delivered enteral therapy (with video): A prospective study  
 
Version: 0 Date: 24 Oct 2019  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other  article types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
Yes - the approach is appropriate  
 
 
EXECUTION - Are the experiments an d analyses performed with technical rigor to allow 
confidence in the results?  
 
No - there are minor issues  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
N/A - there are no statistics in this study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
No - there are minor issues  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make  the work technically sound?  
 
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS:  
 
Overall Impression  
 
 This paper describes experience with a colonoscopiec transendoscopic  delivery system of fecal 
cultures or other active  agents t hat allows direct intraconoc lumenal delivery. The interesting 
part is a system for repeated delivery over a week to several weeks. This is novel methodology 
and may proved very useful in  selected mucosal diseases of the colon. Note that this study 
evalua tes only the methodology of placement of the  transanal catheter for drug delivery and the 
patient tolerance of such an indwelling transanal catheter  
  
 
What have the authors done well  
 
 The authors have described and evaluated a methodology for direct and r epeated intrude 
although delivery of active agents. It needs work on the grammar and word usage but the system 
is well described   
  
 
In what ways does it not meet best practice  
 
 I think that the authors have done a good job at following usual procedures f or an 
observational/prospective  study. The methodology of determining true "patient satisfaction" is 
not tight or well described but the overall big picture is OK.    
 
 
REQUESTED REVISIONS:  
 
Are there additional revisions the authors should make -consider  
 
 1. Would change the phrase "colonic trans - endoscopic tube" to "colonic transendoscopic enteral 
delivery system (CTEDS) which makes much more  sense or to colonic (TEDS)  
 
  2. Lines 27 -29. Here I would suggest that you very briefly describe the fact that  you left the 
delivery catheter within the colon for up to X days (X being the maximum number of days in any 
of the patients)  exiting from the anus  
 
3. Line 34 no one will understand the "titanium clip type" phrase. This needs to be added to the 
methods s ection explaining how and where in colon and on tube the clips were placed  
 
4. Line 52 the phrase "in current (14) or ancient (15)" needs to be replace as written it makes no 
sense  
 
5. Line 60 do you really mean that a patient suffocates? I doubt it!   change the word suffocation 
to something more reasonable? Difficulty breathing, episodes of difficulty breathing , or 
something like that -- I am not certain what you mean by suffocation  
 
6. Line 65. Reword " special structure of the colon" don't you really mean "due to the more distal 
anatomic location of the colon in the gastrointestinal tract and the difficulty delivering the agent 
directly into the colonic lumen"?  
 
7. line 73 reword as "by the long term maintenance of an indwelling, colonoscopically  place d  
transanal catheter  
 
8. Line 86 please round off the 98.1% to a whole number  
 
9. Line 87 and everywhere else in the text -change to "retention time"  
 
10. Line 117. Is the parafin oil used to facilitate removal of the colonoscope over the colonic 
catheter? I f so explain it  
 
11. Line 108 on you need to do a better job describing both the tube( I would change this term to 
catheter) and the technique  of  fixation because the photo does not do it justice, and requiring 
the reader to look at your previous publicat ions is not appropriate. Explain how the clip is fixed 
to the catheter . Also is the catheter made by a company? What is the catheter made from? 
Silicone? Plastic? etc. If so, which company and what is it called in case others want to try to 
obtain such a tube.  Also when describing its initial insertion , inform the reader that there is a 
guide wire within the catheter initially  
 
12. Reword the phrase " line loop" do you mean a markings are placed at 10cm distances from 
the end of the catheter?  
 
13. Is the g uide wire left in while removing the colonoscope over the catheter?  
 
14. Line 160 did the 107 patients only have a one time delivery of medication and the catheter 
was not left in place afterwards? if so say "107 (47.8%) had a one time delivery of FMT" nd t he 
catheter was removed  
 
15 lines 169 - 170. How long did you want the catheter to remain in the colonic lumen?  
 
16. Line 199 reword to " for several types of mucosal diseases of the colon such as ulcerative 
colitis.  
 
17 you use the phrase TET tube. Which when  written out without the abbreviation would be 
transendoscopic enteral tubing  tube" not good  
 
See #1 above  
  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
see above my comprehensive suggestions, but note the text will require some heavy editing if the 
journal does n ot do this then use of a scientific editing service like Accdon (which focuses on 
Chinese submissions)  or Nature editing  or Springer editing will be necessary  
 
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.  
 
No 
 
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  manus cript or would you recommend an 
additional statistical review?  
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 writ ten 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, f ees, funding, or salary 
from an organisation 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 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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution Lic ense 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or 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 included in my named report can be included as confidential comme nts 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant