Title: Gastrostomy Tube Feeding in Children: A Single-Center Experience
Version: 1 Date: 13 Oct 2024
Reviewer:  Riad Rahhal
Reviewer's report:
We thank the authors for this submission. They describe their experience with PEG tube
placement in pediatric population in Switzerland with the hope of filling knowledge gaps related
to that region’s practice and population.
In addition to demographics reported, would recommend adding cohort's race/ethnicity data if
available.
Authors need to clearly define what parameters were used to categorize patients as having
abnormal pH monitoring (what are the references used)
I assume the esogastroduodenal transit study used at this center refers to gastric emptying
scintigraphy (nuclear medicine study). If that is the case, was there any other standardized
imaging requested prior to offering a PEG such as upper GI contrast study to assess for anatomic
concerns (like malrotation, obstruction or other)?
In the abstract, manuscript results and discussion sections, please consistently use the terms
weight Z-score and BMI Z-score rather than weight and BMI
There are a variety of PEG replacement options and processes including pre-procedural, intra-
procedural and post-procedural management pathways used at different centers. It would be
informative to have the authors' protocol and experience specifically on:
• What are the authors’ standard for procedural antimicrobial coverage and duration?
• What is the standard duration from PEG tube placement to first gastrostomy tube switch?
• For device utilization what were the PEG tube sizes (such as 12 French, 14 French or other)
utilized in their series.
• Were PEG placement procedures performed as outpatient or were patients admitted to the
hospital? If admission was standard of care, what was the hospital length of stay before discharge
after routine uncomplicated PEG placement.
Based on the information provided, it seems that PEG placement is the primary gastrostomy
tube type offered at this institution.  Do the authors have data (at least number of patients) who
were evaluated during that same time period and deemed not good candidates for endoscopic
placement and therefore referrals were made to surgery (for surgical G tube placement)?
Lastly, some literature proposed that young children (< 1 year of age) may have higher
complication risk compared to older pediatric patients. What percent of patients were < 1 year
of age and did they experience more complications than the older cohort.
Title: Gastrostomy Tube Feeding in Children: A Single-Center Experience
Version: 1 Date: 13 Oct 2024
Reviewer:  Riad Rahhal
Reviewer's report:
We thank the authors for this submission. They describe their experience with PEG tube
placement in pediatric population in Switzerland with the hope of filling knowledge gaps related
to that region’s practice and population.
In addition to demographics reported, would recommend adding cohort's race/ethnicity data if
available.
Authors need to clearly define what parameters were used to categorize patients as having
abnormal pH monitoring (what are the references used)
I assume the esogastroduodenal transit study used at this center refers to gastric emptying
scintigraphy (nuclear medicine study). If that is the case, was there any other standardized
imaging requested prior to offering a PEG such as upper GI contrast study to assess for anatomic
concerns (like malrotation, obstruction or other)?
In the abstract, manuscript results and discussion sections, please consistently use the terms
weight Z-score and BMI Z-score rather than weight and BMI
There are a variety of PEG replacement options and processes including pre-procedural, intra-
procedural and post-procedural management pathways used at different centers. It would be
informative to have the authors' protocol and experience specifically on:
• What are the authors’ standard for procedural antimicrobial coverage and duration?
• What is the standard duration from PEG tube placement to first gastrostomy tube switch?
• For device utilization what were the PEG tube sizes (such as 12 French, 14 French or other)
utilized in their series.
• Were PEG placement procedures performed as outpatient or were patients admitted to the
hospital? If admission was standard of care, what was the hospital length of stay before discharge
after routine uncomplicated PEG placement.
Based on the information provided, it seems that PEG placement is the primary gastrostomy
tube type offered at this institution.  Do the authors have data (at least number of patients) who
were evaluated during that same time period and deemed not good candidates for endoscopic
placement and therefore referrals were made to surgery (for surgical G tube placement)?
Lastly, some literature proposed that young children (< 1 year of age) may have higher
complication risk compared to older pediatric patients. What percent of patients were < 1 year
of age and did they experience more complications than the older cohort.
Please review this paper.
user
Title: Gastrostomy Tube Feeding in Children: A Single-Center Experience
Version: 1 Date: 13 Oct 2024
Reviewer:  Riad Rahhal
Reviewer's report:
We thank the authors for this submission. They describe their experience with PEG tube
placement in pediatric population in Switzerland with the hope of filling knowledge gaps related
to that region’s practice and population.
In addition to demographics reported, would recommend adding cohort's race/ethnicity data if
available.
Authors need to clearly define what parameters were used to categorize patients as having
abnormal pH monitoring (what are the references used)
I assume the esogastroduodenal transit study used at this center refers to gastric emptying
scintigraphy (nuclear medicine study). If that is the case, was there any other standardized
imaging requested prior to offering a PEG such as upper GI contrast study to assess for anatomic
concerns (like malrotation, obstruction or other)?
In the abstract, manuscript results and discussion sections, please consistently use the terms
weight Z-score and BMI Z-score rather than weight and BMI
There are a variety of PEG replacement options and processes including pre-procedural, intra-
procedural and post-procedural management pathways used at different centers. It would be
informative to have the authors' protocol and experience specifically on:
• What are the authors’ standard for procedural antimicrobial coverage and duration?
• What is the standard duration from PEG tube placement to first gastrostomy tube switch?
• For device utilization what were the PEG tube sizes (such as 12 French, 14 French or other)
utilized in their series.
• Were PEG placement procedures performed as outpatient or were patients admitted to the
hospital? If admission was standard of care, what was the hospital length of stay before discharge
after routine uncomplicated PEG placement.
Based on the information provided, it seems that PEG placement is the primary gastrostomy
tube type offered at this institution.  Do the authors have data (at least number of patients) who
were evaluated during that same time period and deemed not good candidates for endoscopic
placement and therefore referrals were made to surgery (for surgical G tube placement)?
Lastly, some literature proposed that young children (< 1 year of age) may have higher
complication risk compared to older pediatric patients. What percent of patients were < 1 year
of age and did they experience more complications than the older cohort.
assistant