Title: Feasibility, effectiveness, and safety of endoscopic vacuum therapy for intrathoracic
anastomotic leakage following transthoracic esophageal resection
Version: 3 Date: 27 Nov 2020
Reviewer:  Jun Cheul Park
Reviewer's report:
The authors evaluate the feasibility, effectiveness, and safety of EVT for intrathoracic
anastomotic leakage following transthoracic esophageal resection.
The manuscript is well written and would be helpful for the clinician to understand the efficacy
and safety of EVT.
I have some questions about this study as follows.
1. This study was evaluated based on prospectively collected data, and retrospective analysis.
Therefore, authors should clearly state whether this study is prospectively registered.
Since the abstract is described as follows, it may confuse readers whether this is a prospective
study or not.
‘This prospective, single-center study aimed to evaluate the feasibility, effectiveness, and
safety of EVT for intrathoracic anastomotic leakage following abdomino-thoracic esophageal
resection. ‘
2. In this study, stent or EVT was selected as the first endoscopic treatment after a leakage. What
was the criterion for choosing between these two endoscopic methods?
3. It would be better to simply add the process of esophageal diversion in method section.
4. According to leakage size grade, over 60% was small defect. Do these small cases really need
an EVT? I think these cases can be treated with clip or stent.
And the large sized defect which can maximize EVT effect was only 12.7%.
5. In page 11, “four patients with a therapeutic switch to EVT after failure of the SEMS
treatment”
What was the reason for SEMS failure? Please clarify whether it failed due to SEMS
complications (migration, ulcer etc.) or just because of incomplete healing.
Title: Feasibility, effectiveness, and safety of endoscopic vacuum therapy for intrathoracic
anastomotic leakage following transthoracic esophageal resection
Version: 3 Date: 27 Nov 2020
Reviewer:  Jun Cheul Park
Reviewer's report:
The authors evaluate the feasibility, effectiveness, and safety of EVT for intrathoracic
anastomotic leakage following transthoracic esophageal resection.
The manuscript is well written and would be helpful for the clinician to understand the efficacy
and safety of EVT.
I have some questions about this study as follows.
1. This study was evaluated based on prospectively collected data, and retrospective analysis.
Therefore, authors should clearly state whether this study is prospectively registered.
Since the abstract is described as follows, it may confuse readers whether this is a prospective
study or not.
‘This prospective, single-center study aimed to evaluate the feasibility, effectiveness, and
safety of EVT for intrathoracic anastomotic leakage following abdomino-thoracic esophageal
resection. ‘
2. In this study, stent or EVT was selected as the first endoscopic treatment after a leakage. What
was the criterion for choosing between these two endoscopic methods?
3. It would be better to simply add the process of esophageal diversion in method section.
4. According to leakage size grade, over 60% was small defect. Do these small cases really need
an EVT? I think these cases can be treated with clip or stent.
And the large sized defect which can maximize EVT effect was only 12.7%.
5. In page 11, “four patients with a therapeutic switch to EVT after failure of the SEMS
treatment”
What was the reason for SEMS failure? Please clarify whether it failed due to SEMS
complications (migration, ulcer etc.) or just because of incomplete healing.
Please review this paper.
user
Title: Feasibility, effectiveness, and safety of endoscopic vacuum therapy for intrathoracic
anastomotic leakage following transthoracic esophageal resection
Version: 3 Date: 27 Nov 2020
Reviewer:  Jun Cheul Park
Reviewer's report:
The authors evaluate the feasibility, effectiveness, and safety of EVT for intrathoracic
anastomotic leakage following transthoracic esophageal resection.
The manuscript is well written and would be helpful for the clinician to understand the efficacy
and safety of EVT.
I have some questions about this study as follows.
1. This study was evaluated based on prospectively collected data, and retrospective analysis.
Therefore, authors should clearly state whether this study is prospectively registered.
Since the abstract is described as follows, it may confuse readers whether this is a prospective
study or not.
‘This prospective, single-center study aimed to evaluate the feasibility, effectiveness, and
safety of EVT for intrathoracic anastomotic leakage following abdomino-thoracic esophageal
resection. ‘
2. In this study, stent or EVT was selected as the first endoscopic treatment after a leakage. What
was the criterion for choosing between these two endoscopic methods?
3. It would be better to simply add the process of esophageal diversion in method section.
4. According to leakage size grade, over 60% was small defect. Do these small cases really need
an EVT? I think these cases can be treated with clip or stent.
And the large sized defect which can maximize EVT effect was only 12.7%.
5. In page 11, “four patients with a therapeutic switch to EVT after failure of the SEMS
treatment”
What was the reason for SEMS failure? Please clarify whether it failed due to SEMS
complications (migration, ulcer etc.) or just because of incomplete healing.
assistant