Reviewer ’s report  
 
Title: Endoscopic decompression of acute intestinal disten sion is associated with reduced 
mortality in critically ill patients  
 
Version: 1 Date: 14 Nov 2019  
 
Reviewer: Bulent Baran  
 
Reviewer's report:  
 
Dear E ditor,  
 
In this study entitled "Endoscopic decompression of acute intestinal distension is associated with 
reduced mortality in critically ill patients" the investigators included patients with intestinal 
transit failure who had endoscopic intestinal decomp ression tube placement from 2008 to 2019 
in a retrospective study setting to evaluate the technical success, long -term outcome and 
prognostic factors. A total of 59 decompression tubes were placed in 50 patients during the study 
period. Technical success w as achieved in 98% (58/59 tubes) of interventions. Elevated CRP, 
low platelets and high serum lactate levels were associated with non -response to endoscopic 
decompression suggesting that those patients with non -response have more inflammation, more 
severe infection/ sepsis and bone marrow suppression or DIC. Overall the manuscript is well -
written, the subject is important and relevant to the GI practice. However, a suitable hypothesis is 
not available. I would recommend reevaluation after revisions done acc ording to the following 
suggestions.  
 
 
Minor points  
 
1. Please add the months of start and end dates of the study.  
 
2. Did perforation occur due to technical error during endoscopic procedure or intestinal 
obstruction itself?  
 
3. Please evaluate if etiology o f intestinal transit failure (obstruction vs 
pseudoobstruction) affects the outcome of patients who underwent endoscopic 
decompression.  
 
4. Please describe other etiologies in a table.  
 
5. How many patients required surgery?  
 
6. What are the predictors of m ortality after surgery? Does etiology play a role?  
 
7. Which patients with obstructive intestinal transit failure requires surgery as an initial 
strategy and which ones should undergo endoscopic decompression before proceeding 
to surgery?  
 
Are the methods appropriate a nd well described?  
If not, please specify what is required 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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 competin g 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 ac cepted 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://creativecommo ns.org/licenses/by/4.0/ ). I understand 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: Endoscopic decompression of acute intestinal disten sion is associated with reduced 
mortality in critically ill patients  
 
Version: 1 Date: 14 Nov 2019  
 
Reviewer: Bulent Baran  
 
Reviewer's report:  
 
Dear E ditor,  
 
In this study entitled "Endoscopic decompression of acute intestinal distension is associated with 
reduced mortality in critically ill patients" the investigators included patients with intestinal 
transit failure who had endoscopic intestinal decomp ression tube placement from 2008 to 2019 
in a retrospective study setting to evaluate the technical success, long -term outcome and 
prognostic factors. A total of 59 decompression tubes were placed in 50 patients during the study 
period. Technical success w as achieved in 98% (58/59 tubes) of interventions. Elevated CRP, 
low platelets and high serum lactate levels were associated with non -response to endoscopic 
decompression suggesting that those patients with non -response have more inflammation, more 
severe infection/ sepsis and bone marrow suppression or DIC. Overall the manuscript is well -
written, the subject is important and relevant to the GI practice. However, a suitable hypothesis is 
not available. I would recommend reevaluation after revisions done acc ording to the following 
suggestions.  
 
 
Minor points  
 
1. Please add the months of start and end dates of the study.  
 
2. Did perforation occur due to technical error during endoscopic procedure or intestinal 
obstruction itself?  
 
3. Please evaluate if etiology o f intestinal transit failure (obstruction vs 
pseudoobstruction) affects the outcome of patients who underwent endoscopic 
decompression.  
 
4. Please describe other etiologies in a table.  
 
5. How many patients required surgery?  
 
6. What are the predictors of m ortality after surgery? Does etiology play a role?  
 
7. Which patients with obstructive intestinal transit failure requires surgery as an initial 
strategy and which ones should undergo endoscopic decompression before proceeding 
to surgery?  
 
Are the methods appropriate a nd well described?  
If not, please specify what is required 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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 competin g 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 ac cepted 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://creativecommo ns.org/licenses/by/4.0/ ). I understand 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: Endoscopic decompression of acute intestinal disten sion is associated with reduced 
mortality in critically ill patients  
 
Version: 1 Date: 14 Nov 2019  
 
Reviewer: Bulent Baran  
 
Reviewer's report:  
 
Dear E ditor,  
 
In this study entitled "Endoscopic decompression of acute intestinal distension is associated with 
reduced mortality in critically ill patients" the investigators included patients with intestinal 
transit failure who had endoscopic intestinal decomp ression tube placement from 2008 to 2019 
in a retrospective study setting to evaluate the technical success, long -term outcome and 
prognostic factors. A total of 59 decompression tubes were placed in 50 patients during the study 
period. Technical success w as achieved in 98% (58/59 tubes) of interventions. Elevated CRP, 
low platelets and high serum lactate levels were associated with non -response to endoscopic 
decompression suggesting that those patients with non -response have more inflammation, more 
severe infection/ sepsis and bone marrow suppression or DIC. Overall the manuscript is well -
written, the subject is important and relevant to the GI practice. However, a suitable hypothesis is 
not available. I would recommend reevaluation after revisions done acc ording to the following 
suggestions.  
 
 
Minor points  
 
1. Please add the months of start and end dates of the study.  
 
2. Did perforation occur due to technical error during endoscopic procedure or intestinal 
obstruction itself?  
 
3. Please evaluate if etiology o f intestinal transit failure (obstruction vs 
pseudoobstruction) affects the outcome of patients who underwent endoscopic 
decompression.  
 
4. Please describe other etiologies in a table.  
 
5. How many patients required surgery?  
 
6. What are the predictors of m ortality after surgery? Does etiology play a role?  
 
7. Which patients with obstructive intestinal transit failure requires surgery as an initial 
strategy and which ones should undergo endoscopic decompression before proceeding 
to surgery?  
 
Are the methods appropriate a nd well described?  
If not, please specify what is required 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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 competin g 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 ac cepted 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://creativecommo ns.org/licenses/by/4.0/ ). I understand 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