Reviewer ’s report  
 
Title: Endoscopic decompression of acute intestinal disten sion is associated with reduced 
mortality in critically ill patients  
 
Version: 1 Date: 12 Nov 2019  
 
Reviewer: Rizwan Ahamed  
 
Reviewer's report:  
 
Like the authors have mentioned, data is sparse regarding intestinal decompression. Kindly clear 
up a few queries that I have about the study.  
 
1. Majority of the tubes were placed in the colon. Can you elaborate regarding the indication for 
decompression of the colon; at least giving information about whether it was for benign or 
malignant conditions?  
 
2. what were the reasons for delaying surgery in a certain subset of patients?  Can you clarify the 
reasons for delaying surgery when indicated and also how and when it was decided to go ahead  
with surgery after decompression?  
 
3. As regards the significant survival benefit in the treatment response group, I find it difficult to 
understand ho w that conclusion was reached with so many confounding factors. For instance 
how is it possible to compare survival in groups which have both benign and malignant 
conditions  
 
4. Please let us know in more detail about the procedure itself. Very little infor mation is provided 
regarding this in the Methods section when in fact it is of so much importance. The kind of tube 
that was used, whether fluoroscopy was required in certain cases, what kind of anesthesia was 
used for the procedure etc. For the lower GI t ract, most of the tubes were placed in the colon; can 
you specify where the tubes were placed in the upper GI tract?  
 
5. Lastly, the biggest limitation of the study is the heterogeneity of your study population which 
the authors themselves have mentioned m ore than once.  
 
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 controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recomm end 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 reimburs ements, 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 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 a ll 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 interest  
 
I agree to the open peer review policy of the journal. I understand that my nam e will be included 
on my report to the authors and, if the manuscript is accepted 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 availabl e 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 in cluded as confidential comments 
to the editors, which will no t 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: 12 Nov 2019  
 
Reviewer: Rizwan Ahamed  
 
Reviewer's report:  
 
Like the authors have mentioned, data is sparse regarding intestinal decompression. Kindly clear 
up a few queries that I have about the study.  
 
1. Majority of the tubes were placed in the colon. Can you elaborate regarding the indication for 
decompression of the colon; at least giving information about whether it was for benign or 
malignant conditions?  
 
2. what were the reasons for delaying surgery in a certain subset of patients?  Can you clarify the 
reasons for delaying surgery when indicated and also how and when it was decided to go ahead  
with surgery after decompression?  
 
3. As regards the significant survival benefit in the treatment response group, I find it difficult to 
understand ho w that conclusion was reached with so many confounding factors. For instance 
how is it possible to compare survival in groups which have both benign and malignant 
conditions  
 
4. Please let us know in more detail about the procedure itself. Very little infor mation is provided 
regarding this in the Methods section when in fact it is of so much importance. The kind of tube 
that was used, whether fluoroscopy was required in certain cases, what kind of anesthesia was 
used for the procedure etc. For the lower GI t ract, most of the tubes were placed in the colon; can 
you specify where the tubes were placed in the upper GI tract?  
 
5. Lastly, the biggest limitation of the study is the heterogeneity of your study population which 
the authors themselves have mentioned m ore than once.  
 
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 controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recomm end 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 reimburs ements, 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 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 a ll 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 interest  
 
I agree to the open peer review policy of the journal. I understand that my nam e will be included 
on my report to the authors and, if the manuscript is accepted 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 availabl e 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 in cluded as confidential comments 
to the editors, which will no t 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: 12 Nov 2019  
 
Reviewer: Rizwan Ahamed  
 
Reviewer's report:  
 
Like the authors have mentioned, data is sparse regarding intestinal decompression. Kindly clear 
up a few queries that I have about the study.  
 
1. Majority of the tubes were placed in the colon. Can you elaborate regarding the indication for 
decompression of the colon; at least giving information about whether it was for benign or 
malignant conditions?  
 
2. what were the reasons for delaying surgery in a certain subset of patients?  Can you clarify the 
reasons for delaying surgery when indicated and also how and when it was decided to go ahead  
with surgery after decompression?  
 
3. As regards the significant survival benefit in the treatment response group, I find it difficult to 
understand ho w that conclusion was reached with so many confounding factors. For instance 
how is it possible to compare survival in groups which have both benign and malignant 
conditions  
 
4. Please let us know in more detail about the procedure itself. Very little infor mation is provided 
regarding this in the Methods section when in fact it is of so much importance. The kind of tube 
that was used, whether fluoroscopy was required in certain cases, what kind of anesthesia was 
used for the procedure etc. For the lower GI t ract, most of the tubes were placed in the colon; can 
you specify where the tubes were placed in the upper GI tract?  
 
5. Lastly, the biggest limitation of the study is the heterogeneity of your study population which 
the authors themselves have mentioned m ore than once.  
 
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 controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recomm end 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 reimburs ements, 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 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 a ll 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 interest  
 
I agree to the open peer review policy of the journal. I understand that my nam e will be included 
on my report to the authors and, if the manuscript is accepted 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 availabl e 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 in cluded as confidential comments 
to the editors, which will no t be published.  
 
I agree to the open peer review policy of the journal  
assistant