Reviewer’s report
Title: 
Outcomes and survival of infants with congenital duodenal obstruction
following Kimura procedure with post-anastomosis jejunostomy feeding tube
Version: 
1 
Date: 
02 Sep 2020
Reviewer's report:
The authors conducted a retrospective study to analyze whether patients after
Kimura procedure can benefit from a jejunal feeding tube.
They concluded that time to full oral feeding is reduced and duration of
parenteral nutrition is shorter in patients with a jejunal feeding tube after Kimura
procedure for duodenal obstruction.
Following points need further attention:
MAJOR REMARKS
As described by antecedent reviewers, the heterogeneity of the population in
combination with the low numbers is the main problem of this study. This was
already addressed by a separate analysis for male and female patients. However,
this might be problematic due to even lower numbers (table 4, please indicate
N).
Furthermore, patients without congenital anomaly received a JFT twice as much
as patients with congenital anomaly (9/23 vs 6/29). This reduced load of
comorbidities could be responsible for the better outcome in the JFT group. Can
the authors comment on that?
Similarly, more clinical signs in the Non JFT could reflect advanced disease
which could similarly be responsible for a worse outcome in this group. This
goes in line with a higher age at time of surgery in this group.
Having these limitations in mind, this series is important, as no better data exist
at the moment. With adequate discussion of the above mentioned points, this
data is important as long as no randomized trial answers this question.
MINOR REMARKS
- Can the authors comment on the death rate close to 40%, is this number
comparable to similar series?
- Early enteral feeding is to be expected in the JFT group, I would personally not
mention this as a primary result
- As far as I am aware, exact location and technique for placement of the JFT is
not mentioned, this might be interesting for readers
- L163: decreasing the possibility of intestinal adhesions: very hypothetical,
mechanism?
- Professional language editing is recommended.
Publons Reviewer Recognition
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find the details of processing in Publons’ privacy policy
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Yes
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 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 competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Outcomes and survival of infants with congenital duodenal obstruction
following Kimura procedure with post-anastomosis jejunostomy feeding tube
Version: 
1 
Date: 
02 Sep 2020
Reviewer's report:
The authors conducted a retrospective study to analyze whether patients after
Kimura procedure can benefit from a jejunal feeding tube.
They concluded that time to full oral feeding is reduced and duration of
parenteral nutrition is shorter in patients with a jejunal feeding tube after Kimura
procedure for duodenal obstruction.
Following points need further attention:
MAJOR REMARKS
As described by antecedent reviewers, the heterogeneity of the population in
combination with the low numbers is the main problem of this study. This was
already addressed by a separate analysis for male and female patients. However,
this might be problematic due to even lower numbers (table 4, please indicate
N).
Furthermore, patients without congenital anomaly received a JFT twice as much
as patients with congenital anomaly (9/23 vs 6/29). This reduced load of
comorbidities could be responsible for the better outcome in the JFT group. Can
the authors comment on that?
Similarly, more clinical signs in the Non JFT could reflect advanced disease
which could similarly be responsible for a worse outcome in this group. This
goes in line with a higher age at time of surgery in this group.
Having these limitations in mind, this series is important, as no better data exist
at the moment. With adequate discussion of the above mentioned points, this
data is important as long as no randomized trial answers this question.
MINOR REMARKS
- Can the authors comment on the death rate close to 40%, is this number
comparable to similar series?
- Early enteral feeding is to be expected in the JFT group, I would personally not
mention this as a primary result
- As far as I am aware, exact location and technique for placement of the JFT is
not mentioned, this might be interesting for readers
- L163: decreasing the possibility of intestinal adhesions: very hypothetical,
mechanism?
- Professional language editing is recommended.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
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 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 competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Outcomes and survival of infants with congenital duodenal obstruction
following Kimura procedure with post-anastomosis jejunostomy feeding tube
Version: 
1 
Date: 
02 Sep 2020
Reviewer's report:
The authors conducted a retrospective study to analyze whether patients after
Kimura procedure can benefit from a jejunal feeding tube.
They concluded that time to full oral feeding is reduced and duration of
parenteral nutrition is shorter in patients with a jejunal feeding tube after Kimura
procedure for duodenal obstruction.
Following points need further attention:
MAJOR REMARKS
As described by antecedent reviewers, the heterogeneity of the population in
combination with the low numbers is the main problem of this study. This was
already addressed by a separate analysis for male and female patients. However,
this might be problematic due to even lower numbers (table 4, please indicate
N).
Furthermore, patients without congenital anomaly received a JFT twice as much
as patients with congenital anomaly (9/23 vs 6/29). This reduced load of
comorbidities could be responsible for the better outcome in the JFT group. Can
the authors comment on that?
Similarly, more clinical signs in the Non JFT could reflect advanced disease
which could similarly be responsible for a worse outcome in this group. This
goes in line with a higher age at time of surgery in this group.
Having these limitations in mind, this series is important, as no better data exist
at the moment. With adequate discussion of the above mentioned points, this
data is important as long as no randomized trial answers this question.
MINOR REMARKS
- Can the authors comment on the death rate close to 40%, is this number
comparable to similar series?
- Early enteral feeding is to be expected in the JFT group, I would personally not
mention this as a primary result
- As far as I am aware, exact location and technique for placement of the JFT is
not mentioned, this might be interesting for readers
- L163: decreasing the possibility of intestinal adhesions: very hypothetical,
mechanism?
- Professional language editing is recommended.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
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 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 competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant