Title: The important role of whole-process Computed Tomography guidance for percutaneous
gastrostomy in esophageal cancer patients who are unsuitable for or have had unsuccessful
attempts with endoscopic and fluoroscopic gastrostomy
Version: 1 Date: 23 Jun 2023
Reviewer's report:
This is indeed a very interesting study, in which authors have performed research on a very
important topic of nutrition, in patients with specific esophageal problems.  Technically it seems
to be a good procedure, as it is minimally invasive and a good option of feeding patients in
whom either PEG or PFG has failed.
The technique of gastrostomy tube insertion is well explained. However there are some details
which are missing.
The section on materials and methods requires clarification. Only in the discussion it is
mentioned that it was retrospective. It  should have mentioned in materials and methods. How
did the authors collect the data? Was it through hospital computerized  records? Or did they
make phone calls to the patient's family? In that situation there might have been some details
or complications that could have been missed. The author mentions that  all patients  did not
need general anesthesia. Did some need? It is ambiguous and must be cleared which form of
anesthesia, whether local or general was used.
The most common complication after gastrostomy  is usually pain, patient discomfort and
infection. It's surprising that no one was given pre-procedure antibiotics. Authors opinion that
repeated puncture of the liver can occur without any hazard, is alarming. Not every patient can
have repeated puncture without any catastrophic results. Claims such as that should be backed
by some data. Did the patients in this present study have multiple liver punctures? If so, how
many in average and were there any complications or not.
Furthermore, authors have anticipated that massive hemorrhage in the stomach can occur. Were
patients observed for that? Which patients are at risk of it? If it were to occur, how  could that
be identified and tackled. It is important to assess before recommending the procedure. Do the
patients require any follow up after this procedure. How frequent and what should be evaluated
on follow up?  Moreover, was it effective in feeding?
It's basically a study in which only frequencies are addressed.
The discussion needs to be rewritten, as there are many repetitions of the results and meaningful
discussion about the literature is missing. A more detailed comparison between different already
established techniques of gastrostomy, would make it more interesting and informative.
Title: The important role of whole-process Computed Tomography guidance for percutaneous
gastrostomy in esophageal cancer patients who are unsuitable for or have had unsuccessful
attempts with endoscopic and fluoroscopic gastrostomy
Version: 1 Date: 23 Jun 2023
Reviewer's report:
This is indeed a very interesting study, in which authors have performed research on a very
important topic of nutrition, in patients with specific esophageal problems.  Technically it seems
to be a good procedure, as it is minimally invasive and a good option of feeding patients in
whom either PEG or PFG has failed.
The technique of gastrostomy tube insertion is well explained. However there are some details
which are missing.
The section on materials and methods requires clarification. Only in the discussion it is
mentioned that it was retrospective. It  should have mentioned in materials and methods. How
did the authors collect the data? Was it through hospital computerized  records? Or did they
make phone calls to the patient's family? In that situation there might have been some details
or complications that could have been missed. The author mentions that  all patients  did not
need general anesthesia. Did some need? It is ambiguous and must be cleared which form of
anesthesia, whether local or general was used.
The most common complication after gastrostomy  is usually pain, patient discomfort and
infection. It's surprising that no one was given pre-procedure antibiotics. Authors opinion that
repeated puncture of the liver can occur without any hazard, is alarming. Not every patient can
have repeated puncture without any catastrophic results. Claims such as that should be backed
by some data. Did the patients in this present study have multiple liver punctures? If so, how
many in average and were there any complications or not.
Furthermore, authors have anticipated that massive hemorrhage in the stomach can occur. Were
patients observed for that? Which patients are at risk of it? If it were to occur, how  could that
be identified and tackled. It is important to assess before recommending the procedure. Do the
patients require any follow up after this procedure. How frequent and what should be evaluated
on follow up?  Moreover, was it effective in feeding?
It's basically a study in which only frequencies are addressed.
The discussion needs to be rewritten, as there are many repetitions of the results and meaningful
discussion about the literature is missing. A more detailed comparison between different already
established techniques of gastrostomy, would make it more interesting and informative.
Please review this paper.
user
Title: The important role of whole-process Computed Tomography guidance for percutaneous
gastrostomy in esophageal cancer patients who are unsuitable for or have had unsuccessful
attempts with endoscopic and fluoroscopic gastrostomy
Version: 1 Date: 23 Jun 2023
Reviewer's report:
This is indeed a very interesting study, in which authors have performed research on a very
important topic of nutrition, in patients with specific esophageal problems.  Technically it seems
to be a good procedure, as it is minimally invasive and a good option of feeding patients in
whom either PEG or PFG has failed.
The technique of gastrostomy tube insertion is well explained. However there are some details
which are missing.
The section on materials and methods requires clarification. Only in the discussion it is
mentioned that it was retrospective. It  should have mentioned in materials and methods. How
did the authors collect the data? Was it through hospital computerized  records? Or did they
make phone calls to the patient's family? In that situation there might have been some details
or complications that could have been missed. The author mentions that  all patients  did not
need general anesthesia. Did some need? It is ambiguous and must be cleared which form of
anesthesia, whether local or general was used.
The most common complication after gastrostomy  is usually pain, patient discomfort and
infection. It's surprising that no one was given pre-procedure antibiotics. Authors opinion that
repeated puncture of the liver can occur without any hazard, is alarming. Not every patient can
have repeated puncture without any catastrophic results. Claims such as that should be backed
by some data. Did the patients in this present study have multiple liver punctures? If so, how
many in average and were there any complications or not.
Furthermore, authors have anticipated that massive hemorrhage in the stomach can occur. Were
patients observed for that? Which patients are at risk of it? If it were to occur, how  could that
be identified and tackled. It is important to assess before recommending the procedure. Do the
patients require any follow up after this procedure. How frequent and what should be evaluated
on follow up?  Moreover, was it effective in feeding?
It's basically a study in which only frequencies are addressed.
The discussion needs to be rewritten, as there are many repetitions of the results and meaningful
discussion about the literature is missing. A more detailed comparison between different already
established techniques of gastrostomy, would make it more interesting and informative.
assistant