Reviewer's report
Title:Case series of Meckel's diverticulum: usefulness of double-balloon
enteroscopy for diagnosis
Version:2Date:28 May 2014
Reviewer: Ming-wei Lai
Reviewer's report:
Comments:
This case series presented usage of enteroscopy in the diagnosis of Meckel’s
diverticulum (MD) with the maximal number of cases so far. Detailed work-up
history in every case was also presented. It may provide valuable experience and
change the algorithm of diagnostic planning for symptomatic MD in the future.
1. Title should be “A”case series of Meckel’sdiverticulum: usefulness of
double-balloon enteroscopy for diagnosis [Minor Essential Revisions]
2. From your case series, Technetium-99m pertechnetatescintigraphy(MD scan)
was applied in five cases but only positive in one case. The sensitivity was only
20%, which is quite low in comparison with the literature (in children, it has a
sensitivity of 80%-90%; in the adults, around 60%). From the pathology results,
two of the five cases had ectopic gastric mucosa but only one was detected by
MD scan. Did the authors give cimetidine or glucagon to enhance the sensitivity
of MD scan? Because MD scan is a non-invasive, fairly sensitive and cheaper
exam, it is widely used in diagnosing MD presented with lower GI bleeding. Can
the authors comment on its role in the enteroscopy era vs. before enteroscopy
era in your experience? [Discretionary Revisions]
3. In the manuscript, about case 4, the abdominal CT finding was a mass but in
the supplementary table, it denoted intussusception. Please clarify it. [Minor
Essential Revisions]
4. In case 4, endoscopic resection was performed during enteroscopy under the
impression of a lipoma, which turned out to be an inverted MD. Fortunately, there
was no complication of perforation. Do the authors recommend endoscopic
resection if it is encountered again? Some literature applied enteroscopic
hemostasis for bleeding MD without surgical resection, what is the authors’
opinion on non-surgical therapy for MD? [Discretionary Revisions]
5. After your experience in 10 cases of MD, diagnosed via various modalities of
exam, what is your future algorithm or recommendation in the diagnosis of
symptomatic MD? Several cases in your series were diagnosed by more than
one exam before surgical excision, is that justified in every case? Some cases
may be presented in emergent condition requiring prompt diagnosis, what is your
recommended exam of choice in the future? [Discretionary Revisions]
6. From the authors’ experience, some pearls about performing enteroscopy in
cases suspected of MD may be provided to the readers who wish to follow. Is
there any contraindication for enteroscopy in such cases? From anatomic
location of MD, retrograde enteroscopy is expected to be more helpful. Two
antegrade enteroscopy procedures were performed due to the concern of
massive blood obscuring the retrograde route but only indirectly showed
diverticulum in one. What is your suggestion for the preferred route of
enteroscopy in such condition? Symptomatic MD may be presented more in
childhood, what is the age restriction in enteroscopy in an experienced hand?
[Discretionary Revisions]
7. In figure 2, please use arrows to mark the diverticulum in the CT image A and
B.
[Minor Essential Revisions]
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:28 May 2014
Reviewer: Ming-wei Lai
Reviewer's report:
Comments:
This case series presented usage of enteroscopy in the diagnosis of Meckel’s
diverticulum (MD) with the maximal number of cases so far. Detailed work-up
history in every case was also presented. It may provide valuable experience and
change the algorithm of diagnostic planning for symptomatic MD in the future.
1. Title should be “A”case series of Meckel’sdiverticulum: usefulness of
double-balloon enteroscopy for diagnosis [Minor Essential Revisions]
2. From your case series, Technetium-99m pertechnetatescintigraphy(MD scan)
was applied in five cases but only positive in one case. The sensitivity was only
20%, which is quite low in comparison with the literature (in children, it has a
sensitivity of 80%-90%; in the adults, around 60%). From the pathology results,
two of the five cases had ectopic gastric mucosa but only one was detected by
MD scan. Did the authors give cimetidine or glucagon to enhance the sensitivity
of MD scan? Because MD scan is a non-invasive, fairly sensitive and cheaper
exam, it is widely used in diagnosing MD presented with lower GI bleeding. Can
the authors comment on its role in the enteroscopy era vs. before enteroscopy
era in your experience? [Discretionary Revisions]
3. In the manuscript, about case 4, the abdominal CT finding was a mass but in
the supplementary table, it denoted intussusception. Please clarify it. [Minor
Essential Revisions]
4. In case 4, endoscopic resection was performed during enteroscopy under the
impression of a lipoma, which turned out to be an inverted MD. Fortunately, there
was no complication of perforation. Do the authors recommend endoscopic
resection if it is encountered again? Some literature applied enteroscopic
hemostasis for bleeding MD without surgical resection, what is the authors’
opinion on non-surgical therapy for MD? [Discretionary Revisions]
5. After your experience in 10 cases of MD, diagnosed via various modalities of
exam, what is your future algorithm or recommendation in the diagnosis of
symptomatic MD? Several cases in your series were diagnosed by more than
one exam before surgical excision, is that justified in every case? Some cases
may be presented in emergent condition requiring prompt diagnosis, what is your
recommended exam of choice in the future? [Discretionary Revisions]
6. From the authors’ experience, some pearls about performing enteroscopy in
cases suspected of MD may be provided to the readers who wish to follow. Is
there any contraindication for enteroscopy in such cases? From anatomic
location of MD, retrograde enteroscopy is expected to be more helpful. Two
antegrade enteroscopy procedures were performed due to the concern of
massive blood obscuring the retrograde route but only indirectly showed
diverticulum in one. What is your suggestion for the preferred route of
enteroscopy in such condition? Symptomatic MD may be presented more in
childhood, what is the age restriction in enteroscopy in an experienced hand?
[Discretionary Revisions]
7. In figure 2, please use arrows to mark the diverticulum in the CT image A and
B.
[Minor Essential Revisions]
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:28 May 2014
Reviewer: Ming-wei Lai
Reviewer's report:
Comments:
This case series presented usage of enteroscopy in the diagnosis of Meckel’s
diverticulum (MD) with the maximal number of cases so far. Detailed work-up
history in every case was also presented. It may provide valuable experience and
change the algorithm of diagnostic planning for symptomatic MD in the future.
1. Title should be “A”case series of Meckel’sdiverticulum: usefulness of
double-balloon enteroscopy for diagnosis [Minor Essential Revisions]
2. From your case series, Technetium-99m pertechnetatescintigraphy(MD scan)
was applied in five cases but only positive in one case. The sensitivity was only
20%, which is quite low in comparison with the literature (in children, it has a
sensitivity of 80%-90%; in the adults, around 60%). From the pathology results,
two of the five cases had ectopic gastric mucosa but only one was detected by
MD scan. Did the authors give cimetidine or glucagon to enhance the sensitivity
of MD scan? Because MD scan is a non-invasive, fairly sensitive and cheaper
exam, it is widely used in diagnosing MD presented with lower GI bleeding. Can
the authors comment on its role in the enteroscopy era vs. before enteroscopy
era in your experience? [Discretionary Revisions]
3. In the manuscript, about case 4, the abdominal CT finding was a mass but in
the supplementary table, it denoted intussusception. Please clarify it. [Minor
Essential Revisions]
4. In case 4, endoscopic resection was performed during enteroscopy under the
impression of a lipoma, which turned out to be an inverted MD. Fortunately, there
was no complication of perforation. Do the authors recommend endoscopic
resection if it is encountered again? Some literature applied enteroscopic
hemostasis for bleeding MD without surgical resection, what is the authors’
opinion on non-surgical therapy for MD? [Discretionary Revisions]
5. After your experience in 10 cases of MD, diagnosed via various modalities of
exam, what is your future algorithm or recommendation in the diagnosis of
symptomatic MD? Several cases in your series were diagnosed by more than
one exam before surgical excision, is that justified in every case? Some cases
may be presented in emergent condition requiring prompt diagnosis, what is your
recommended exam of choice in the future? [Discretionary Revisions]
6. From the authors’ experience, some pearls about performing enteroscopy in
cases suspected of MD may be provided to the readers who wish to follow. Is
there any contraindication for enteroscopy in such cases? From anatomic
location of MD, retrograde enteroscopy is expected to be more helpful. Two
antegrade enteroscopy procedures were performed due to the concern of
massive blood obscuring the retrograde route but only indirectly showed
diverticulum in one. What is your suggestion for the preferred route of
enteroscopy in such condition? Symptomatic MD may be presented more in
childhood, what is the age restriction in enteroscopy in an experienced hand?
[Discretionary Revisions]
7. In figure 2, please use arrows to mark the diverticulum in the CT image A and
B.
[Minor Essential Revisions]
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.
assistant