Reviewer ’s report  
 
Title: A case of type 1 multiple endocrine neoplasia with esophageal stricture successfully 
treated with endoscopic balloon dilation and local steroid injection combined with surgical 
resection of gastrinomas  
 
Version: 0 Date: 04 May 2016  
 
Reviewer: Ping-Hsien Chen  
 
Reviewer's report:  
 
This cas e report give us a good education that doctors should be aware of possible ZES in 
patients with refractory peptic ulcers and severe GERD for a long time. In MEN1/ZES, severe 
eosphagitis with stricture can occur in 5 -10% patients. Endocopic balloon dilation  for treating 
benign esophageal stricture is also not a news. The more interest in this case is about treatments 
of MEN1/ZES. Though the pancreatic neuroendocrine tumor with weakly positive immunostain 
of gastrin was found in this case. It is not represent ed that the symptoms of ZES in this case was 
related to p -NET other than duodenal NET because most of p -NET in MEN -I is non -functional. 
Therefore, the treatment about this patient should be discussed into two directions. One is 
medical treatment. Due to mo re benign course and multiple lesions of MEN1/ZES, medical 
treatment for inhibiting acid to control symptoms is more important than surgery. So, the author 
should give us information about the medical treatment (like PPI dose and duration) before 
surgical and endocopic treatment. The second point is about surgery in MEN1/ZES. When to 
receive surgery and what kind of surgical method (local resection or pancreatoduodenectomy) is 
still unknown, so the author can disccus more detail about the decision of 
pancre atodudenectomy. Finally, i think this case give us the opinion that endoscopic dilation for 
treating esophageal stricture is useful after acid control in MEN1/ZES, but the need of 
combination of surgery is still under investigation.  
Are the methods appropriate and 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 control s 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 manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
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, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financi ally 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 organiz ation 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 th e above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for 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://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agre e to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: A case of type 1 multiple endocrine neoplasia with esophageal stricture successfully 
treated with endoscopic balloon dilation and local steroid injection combined with surgical 
resection of gastrinomas  
 
Version: 0 Date: 04 May 2016  
 
Reviewer: Ping-Hsien Chen  
 
Reviewer's report:  
 
This cas e report give us a good education that doctors should be aware of possible ZES in 
patients with refractory peptic ulcers and severe GERD for a long time. In MEN1/ZES, severe 
eosphagitis with stricture can occur in 5 -10% patients. Endocopic balloon dilation  for treating 
benign esophageal stricture is also not a news. The more interest in this case is about treatments 
of MEN1/ZES. Though the pancreatic neuroendocrine tumor with weakly positive immunostain 
of gastrin was found in this case. It is not represent ed that the symptoms of ZES in this case was 
related to p -NET other than duodenal NET because most of p -NET in MEN -I is non -functional. 
Therefore, the treatment about this patient should be discussed into two directions. One is 
medical treatment. Due to mo re benign course and multiple lesions of MEN1/ZES, medical 
treatment for inhibiting acid to control symptoms is more important than surgery. So, the author 
should give us information about the medical treatment (like PPI dose and duration) before 
surgical and endocopic treatment. The second point is about surgery in MEN1/ZES. When to 
receive surgery and what kind of surgical method (local resection or pancreatoduodenectomy) is 
still unknown, so the author can disccus more detail about the decision of 
pancre atodudenectomy. Finally, i think this case give us the opinion that endoscopic dilation for 
treating esophageal stricture is useful after acid control in MEN1/ZES, but the need of 
combination of surgery is still under investigation.  
Are the methods appropriate and 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 control s 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 manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
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, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financi ally 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 organiz ation 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 th e above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for 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://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agre e to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: A case of type 1 multiple endocrine neoplasia with esophageal stricture successfully 
treated with endoscopic balloon dilation and local steroid injection combined with surgical 
resection of gastrinomas  
 
Version: 0 Date: 04 May 2016  
 
Reviewer: Ping-Hsien Chen  
 
Reviewer's report:  
 
This cas e report give us a good education that doctors should be aware of possible ZES in 
patients with refractory peptic ulcers and severe GERD for a long time. In MEN1/ZES, severe 
eosphagitis with stricture can occur in 5 -10% patients. Endocopic balloon dilation  for treating 
benign esophageal stricture is also not a news. The more interest in this case is about treatments 
of MEN1/ZES. Though the pancreatic neuroendocrine tumor with weakly positive immunostain 
of gastrin was found in this case. It is not represent ed that the symptoms of ZES in this case was 
related to p -NET other than duodenal NET because most of p -NET in MEN -I is non -functional. 
Therefore, the treatment about this patient should be discussed into two directions. One is 
medical treatment. Due to mo re benign course and multiple lesions of MEN1/ZES, medical 
treatment for inhibiting acid to control symptoms is more important than surgery. So, the author 
should give us information about the medical treatment (like PPI dose and duration) before 
surgical and endocopic treatment. The second point is about surgery in MEN1/ZES. When to 
receive surgery and what kind of surgical method (local resection or pancreatoduodenectomy) is 
still unknown, so the author can disccus more detail about the decision of 
pancre atodudenectomy. Finally, i think this case give us the opinion that endoscopic dilation for 
treating esophageal stricture is useful after acid control in MEN1/ZES, but the need of 
combination of surgery is still under investigation.  
Are the methods appropriate and 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 control s 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 manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
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, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financi ally 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 organiz ation 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 th e above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for 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://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agre e to the open peer review policy of the journal  
assistant