Reviewer ’s report  
 
Title: Differences between intentional and accidental ingestion of foreign body in China  
 
Version: 0 Date: 24 Dec 2019  
 
Reviewer: James H. Tabibian  
 
Reviewer's report:  
 
The authors evaluated and compared patient demographics and presentation/management of 
intentional vs. accidental foreign body ingestion in a single center in China over 8 years. They 
present interesting data regarding the different types of ingested foreign bodies seen in China, 
which not surprisi ngly is somewhat different from other regions around the world. However, 
there are significant language/logic errors throughout this manuscript that are particularly 
pronounced in the discussion section, limiting understanding of how the authors interpret their 
results and moderating the reader's enthusiasm. It is indeed difficult to understand many of the 
authors' discussion points. It is also unclear why this study was performed. Why is it important to 
compare patient demographics and presentation/managem ent of intentional vs. accidental foreign 
body ingestion? Is there practical value/does this impact management? In addition, there are 
several comments about the study to consider, as stated below:  
 
1. What is the demographic of the patients in the acciden tal ingestion group? While group A 
consisted of prisoners and patients with mental disabilities, did group B also have patients that 
were prisoners and/or have psychiatric disorders? This was not reported.  
 
2. In the results section of the abstract, what is  meant by "mental objects"?  (perhaps it should be 
"metallic"?)  Also, the number of patients in group B should be clearly stated (as it was for group 
A). 
 
3. Why were more of the patients male in Group A? As most of the patients in Group A are 
prisoners, i t would be helpful to know what percentage of prisoners are male; perhaps the male 
predilection is simply a reflection of the prisoner demographic?  
 
4. The authors state that most intentional foreign bodies were found in the stomach and give a 
hypothesis t hat "swallowing intentionally may help the FBs to pass through the esophagus". 
Perhaps the authors can better explain how swallowing intentionally helps foreign bodies to pass, 
especially since esophageal function is largely involuntary. The authors should  also consider the 
fact that 1) patients who had intentional ingestions had longer times to presentation, thus 
allowing for more time for an object to transit through the gastrointestional tract (i.e. from the 
esophagus into the stomach), and that 2) patie nts with accidental ingestion were more likely to 
have esophageal disease (as reported in the authors' study), thus preventing food from 
transitioning to the stomach.  
 
5. How are the authors able to state that "initial identification and radiographic localization" is 
the reason that their failure rates were lower than in previous studies? Was radiography 
performed at higher rates in this study than previous studies?  
 
6. The authors conclude that attention should be focused on patients with intentionally ingested 
foreign bodies. Why? Was risk of mortality or complication (e.g. perforation) higher in this 
population?  
 
Are the methods appropriate and well described?  
If not, please specify what is require d in your comments to the authors.  
 
Yes 
 
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 ex plain 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 
asses sment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
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 financially from the 
publi cation 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 curr ently 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  
 
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 for publication, my named repo rt 
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 understan d that any comments 
which I do not wish to be included in my named report can be in cluded 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: Differences between intentional and accidental ingestion of foreign body in China  
 
Version: 0 Date: 24 Dec 2019  
 
Reviewer: James H. Tabibian  
 
Reviewer's report:  
 
The authors evaluated and compared patient demographics and presentation/management of 
intentional vs. accidental foreign body ingestion in a single center in China over 8 years. They 
present interesting data regarding the different types of ingested foreign bodies seen in China, 
which not surprisi ngly is somewhat different from other regions around the world. However, 
there are significant language/logic errors throughout this manuscript that are particularly 
pronounced in the discussion section, limiting understanding of how the authors interpret their 
results and moderating the reader's enthusiasm. It is indeed difficult to understand many of the 
authors' discussion points. It is also unclear why this study was performed. Why is it important to 
compare patient demographics and presentation/managem ent of intentional vs. accidental foreign 
body ingestion? Is there practical value/does this impact management? In addition, there are 
several comments about the study to consider, as stated below:  
 
1. What is the demographic of the patients in the acciden tal ingestion group? While group A 
consisted of prisoners and patients with mental disabilities, did group B also have patients that 
were prisoners and/or have psychiatric disorders? This was not reported.  
 
2. In the results section of the abstract, what is  meant by "mental objects"?  (perhaps it should be 
"metallic"?)  Also, the number of patients in group B should be clearly stated (as it was for group 
A). 
 
3. Why were more of the patients male in Group A? As most of the patients in Group A are 
prisoners, i t would be helpful to know what percentage of prisoners are male; perhaps the male 
predilection is simply a reflection of the prisoner demographic?  
 
4. The authors state that most intentional foreign bodies were found in the stomach and give a 
hypothesis t hat "swallowing intentionally may help the FBs to pass through the esophagus". 
Perhaps the authors can better explain how swallowing intentionally helps foreign bodies to pass, 
especially since esophageal function is largely involuntary. The authors should  also consider the 
fact that 1) patients who had intentional ingestions had longer times to presentation, thus 
allowing for more time for an object to transit through the gastrointestional tract (i.e. from the 
esophagus into the stomach), and that 2) patie nts with accidental ingestion were more likely to 
have esophageal disease (as reported in the authors' study), thus preventing food from 
transitioning to the stomach.  
 
5. How are the authors able to state that "initial identification and radiographic localization" is 
the reason that their failure rates were lower than in previous studies? Was radiography 
performed at higher rates in this study than previous studies?  
 
6. The authors conclude that attention should be focused on patients with intentionally ingested 
foreign bodies. Why? Was risk of mortality or complication (e.g. perforation) higher in this 
population?  
 
Are the methods appropriate and well described?  
If not, please specify what is require d in your comments to the authors.  
 
Yes 
 
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 ex plain 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 
asses sment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
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 financially from the 
publi cation 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 curr ently 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  
 
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 for publication, my named repo rt 
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 understan d that any comments 
which I do not wish to be included in my named report can be in cluded 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: Differences between intentional and accidental ingestion of foreign body in China  
 
Version: 0 Date: 24 Dec 2019  
 
Reviewer: James H. Tabibian  
 
Reviewer's report:  
 
The authors evaluated and compared patient demographics and presentation/management of 
intentional vs. accidental foreign body ingestion in a single center in China over 8 years. They 
present interesting data regarding the different types of ingested foreign bodies seen in China, 
which not surprisi ngly is somewhat different from other regions around the world. However, 
there are significant language/logic errors throughout this manuscript that are particularly 
pronounced in the discussion section, limiting understanding of how the authors interpret their 
results and moderating the reader's enthusiasm. It is indeed difficult to understand many of the 
authors' discussion points. It is also unclear why this study was performed. Why is it important to 
compare patient demographics and presentation/managem ent of intentional vs. accidental foreign 
body ingestion? Is there practical value/does this impact management? In addition, there are 
several comments about the study to consider, as stated below:  
 
1. What is the demographic of the patients in the acciden tal ingestion group? While group A 
consisted of prisoners and patients with mental disabilities, did group B also have patients that 
were prisoners and/or have psychiatric disorders? This was not reported.  
 
2. In the results section of the abstract, what is  meant by "mental objects"?  (perhaps it should be 
"metallic"?)  Also, the number of patients in group B should be clearly stated (as it was for group 
A). 
 
3. Why were more of the patients male in Group A? As most of the patients in Group A are 
prisoners, i t would be helpful to know what percentage of prisoners are male; perhaps the male 
predilection is simply a reflection of the prisoner demographic?  
 
4. The authors state that most intentional foreign bodies were found in the stomach and give a 
hypothesis t hat "swallowing intentionally may help the FBs to pass through the esophagus". 
Perhaps the authors can better explain how swallowing intentionally helps foreign bodies to pass, 
especially since esophageal function is largely involuntary. The authors should  also consider the 
fact that 1) patients who had intentional ingestions had longer times to presentation, thus 
allowing for more time for an object to transit through the gastrointestional tract (i.e. from the 
esophagus into the stomach), and that 2) patie nts with accidental ingestion were more likely to 
have esophageal disease (as reported in the authors' study), thus preventing food from 
transitioning to the stomach.  
 
5. How are the authors able to state that "initial identification and radiographic localization" is 
the reason that their failure rates were lower than in previous studies? Was radiography 
performed at higher rates in this study than previous studies?  
 
6. The authors conclude that attention should be focused on patients with intentionally ingested 
foreign bodies. Why? Was risk of mortality or complication (e.g. perforation) higher in this 
population?  
 
Are the methods appropriate and well described?  
If not, please specify what is require d in your comments to the authors.  
 
Yes 
 
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 ex plain 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 
asses sment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
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 financially from the 
publi cation 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 curr ently 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  
 
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 for publication, my named repo rt 
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 understan d that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant