Reviewer ’s report  
 
Title: Stretta radiofrequency treatment vs Toupet fundoplicat ion for gastroesophageal reflux 
disease: A comparative study  
 
Version: 0 Date: 26 Feb 2020  
 
Reviewer: Serhat Bor  
 
Reviewer's report:  
 
I read the article entitled "Stretta radiofrequency treatment vs Toupet fundoplication for 
gastroesophageal reflux disease: A comparative therapeutic study"  
 
This is one of the largest study comparing Stretta rad iofrequency treatment (SRF) vs Toupet 
Fundoplication (TF). One year follow up is a success for such a big series. It looks like all 
patients were evaluated with diagnostics such as 24h pH monitoring before and after the 
procedures. Actually this is a non -inferiority study. Main result is particulary important 
showing that SRF is a as good as TF. We certainly needed such large studies. However there 
are many concerns;  
 
1) The manuscript needs a substantial editing for the language. I counted 16 "reflex" 
inste ad of "reflux" in the text.  
 
2) The biggest surprise from my side is GERD -related death concept. 6/226 patients 
were death due to serious complications of GERD. I have never seen any GERD -related 
death unless there would be some procedure -related complicat ions or Barrett -related cancer. I 
would like to know  the reasons of mortality, whether procedure -related or other reasons 
which should be explained anyway. Even though this is a retrospective analysis, if authors 
could perform all the procedures one year after the procedure, they should also collect the 
mortalities. According to the comments above "Endpoint event was the death of patients due 
to GERD -related complications" should be re -evaluated and discussed.  
 
3) Another poor prognosis criteria was "chron ic pain", what kind of pain referred here?  
 
4) While mentioning GERD relapse, I suggest to give the normalization values and 
numbers of patients after 12 mos according to the pH monitoring. "Relapse" is mentioned 
onşy in a table table but I believe it is th e primary end point.  
 
5) Stretta procedure was not clearly defined (This catheter was advanced for 0.5 cm to 
repeat the process over the area 2 cm above and 1.5 cm below the squamo -columnar junction) 
but as far as I understood, only 4 applications were per formed within the esophagus. Under 
the regular conditions (except Sleeve and some other rare situations), nearly all centers 
perform with 14 applications, 8 esophagus + 6 cardia. Is it possible to give more details? If 
authors really have performed with 4 localizations only, this results are even more interesting. 
Because they achieved a non -inferiority data with less applications.  
 
6) What kind of surgery performed; open or laparoscopic? It is not mentioned in the 
text. If it is open surgery, is it possible  that operated patients are less happy because of the 
problems related with open surgery compared to laparoscopic?  
 
7) What is the reason of stopping medications before the procedure or exclude the 
cases? It is not suggested anywhere. It also makes sense to  perform both procedures on -PPI. 
By the way PPIs are acid -inhibitors not acid makings, should be corrected (Medications such 
as anti -cholinesterase drugs and acid -making agents that may affect esophageal motor 
function and secretion of gastric acid were di scontinued 7 days before the assessment.)  
 
8) One of the inclusion criteria was "foreign body sensation in the throat", this 
sentence in the text was also linked a case report in pub -med (when click on the sentence). 
This is not a GERD symptom by itself nor  it is an indication or important for the typical 
cases. Would you like to comment?  
 
9) Stretta catheters have been producing by non -Chinese companies (owner keeps 
changing) however authors mentioned that radiofrequency instrument is from Kanglian 
Medical E quipment Co., Ltd., Beijing. Could you please clarify? Catheters and generator are 
from different companies?  
 
10) It is mentioned in the text that "LES pressure was measured using XDJ -S8S 
Gastrointestinal Pressure Meter (Kelly Photoelectrics Technology Co.,  Ltd., Hefei, China)". 
Is this an esophageal motility system? If yes, please provide the details.  
 
11) Did esophageal motility perform before the procedure and before the pH probe 
insertion?  
 
12) This result is interesting "two parameters. The DeMeester scor e at 12 month after 
surgery was higher in the SRF group than that in the TF group, while the LES pressure was 
the opposite, suggesting that SRF is more effective to increase the esophageal pH and reduce 
the LES pressure in GERD patients." Is it possible to  speculate about the possible reasons? 
Also the sentence should be corrected.  
 
13) The term "gastroscopic endoscopy" should be corrected  
 
14) I suggest to change the title, drop "therapeutic"  
 
15) I could not understand the table 4 because it is in a bad shape following pdf.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported  by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend 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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declara tion of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from 
an organisation that may in any way gain or los e 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 t hat 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 s alary 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 compet ing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name 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 available under an Open Access C reative 
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 not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Stretta radiofrequency treatment vs Toupet fundoplicat ion for gastroesophageal reflux 
disease: A comparative study  
 
Version: 0 Date: 26 Feb 2020  
 
Reviewer: Serhat Bor  
 
Reviewer's report:  
 
I read the article entitled "Stretta radiofrequency treatment vs Toupet fundoplication for 
gastroesophageal reflux disease: A comparative therapeutic study"  
 
This is one of the largest study comparing Stretta rad iofrequency treatment (SRF) vs Toupet 
Fundoplication (TF). One year follow up is a success for such a big series. It looks like all 
patients were evaluated with diagnostics such as 24h pH monitoring before and after the 
procedures. Actually this is a non -inferiority study. Main result is particulary important 
showing that SRF is a as good as TF. We certainly needed such large studies. However there 
are many concerns;  
 
1) The manuscript needs a substantial editing for the language. I counted 16 "reflex" 
inste ad of "reflux" in the text.  
 
2) The biggest surprise from my side is GERD -related death concept. 6/226 patients 
were death due to serious complications of GERD. I have never seen any GERD -related 
death unless there would be some procedure -related complicat ions or Barrett -related cancer. I 
would like to know  the reasons of mortality, whether procedure -related or other reasons 
which should be explained anyway. Even though this is a retrospective analysis, if authors 
could perform all the procedures one year after the procedure, they should also collect the 
mortalities. According to the comments above "Endpoint event was the death of patients due 
to GERD -related complications" should be re -evaluated and discussed.  
 
3) Another poor prognosis criteria was "chron ic pain", what kind of pain referred here?  
 
4) While mentioning GERD relapse, I suggest to give the normalization values and 
numbers of patients after 12 mos according to the pH monitoring. "Relapse" is mentioned 
onşy in a table table but I believe it is th e primary end point.  
 
5) Stretta procedure was not clearly defined (This catheter was advanced for 0.5 cm to 
repeat the process over the area 2 cm above and 1.5 cm below the squamo -columnar junction) 
but as far as I understood, only 4 applications were per formed within the esophagus. Under 
the regular conditions (except Sleeve and some other rare situations), nearly all centers 
perform with 14 applications, 8 esophagus + 6 cardia. Is it possible to give more details? If 
authors really have performed with 4 localizations only, this results are even more interesting. 
Because they achieved a non -inferiority data with less applications.  
 
6) What kind of surgery performed; open or laparoscopic? It is not mentioned in the 
text. If it is open surgery, is it possible  that operated patients are less happy because of the 
problems related with open surgery compared to laparoscopic?  
 
7) What is the reason of stopping medications before the procedure or exclude the 
cases? It is not suggested anywhere. It also makes sense to  perform both procedures on -PPI. 
By the way PPIs are acid -inhibitors not acid makings, should be corrected (Medications such 
as anti -cholinesterase drugs and acid -making agents that may affect esophageal motor 
function and secretion of gastric acid were di scontinued 7 days before the assessment.)  
 
8) One of the inclusion criteria was "foreign body sensation in the throat", this 
sentence in the text was also linked a case report in pub -med (when click on the sentence). 
This is not a GERD symptom by itself nor  it is an indication or important for the typical 
cases. Would you like to comment?  
 
9) Stretta catheters have been producing by non -Chinese companies (owner keeps 
changing) however authors mentioned that radiofrequency instrument is from Kanglian 
Medical E quipment Co., Ltd., Beijing. Could you please clarify? Catheters and generator are 
from different companies?  
 
10) It is mentioned in the text that "LES pressure was measured using XDJ -S8S 
Gastrointestinal Pressure Meter (Kelly Photoelectrics Technology Co.,  Ltd., Hefei, China)". 
Is this an esophageal motility system? If yes, please provide the details.  
 
11) Did esophageal motility perform before the procedure and before the pH probe 
insertion?  
 
12) This result is interesting "two parameters. The DeMeester scor e at 12 month after 
surgery was higher in the SRF group than that in the TF group, while the LES pressure was 
the opposite, suggesting that SRF is more effective to increase the esophageal pH and reduce 
the LES pressure in GERD patients." Is it possible to  speculate about the possible reasons? 
Also the sentence should be corrected.  
 
13) The term "gastroscopic endoscopy" should be corrected  
 
14) I suggest to change the title, drop "therapeutic"  
 
15) I could not understand the table 4 because it is in a bad shape following pdf.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported  by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend 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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declara tion of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from 
an organisation that may in any way gain or los e 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 t hat 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 s alary 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 compet ing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name 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 available under an Open Access C reative 
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 not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Stretta radiofrequency treatment vs Toupet fundoplicat ion for gastroesophageal reflux 
disease: A comparative study  
 
Version: 0 Date: 26 Feb 2020  
 
Reviewer: Serhat Bor  
 
Reviewer's report:  
 
I read the article entitled "Stretta radiofrequency treatment vs Toupet fundoplication for 
gastroesophageal reflux disease: A comparative therapeutic study"  
 
This is one of the largest study comparing Stretta rad iofrequency treatment (SRF) vs Toupet 
Fundoplication (TF). One year follow up is a success for such a big series. It looks like all 
patients were evaluated with diagnostics such as 24h pH monitoring before and after the 
procedures. Actually this is a non -inferiority study. Main result is particulary important 
showing that SRF is a as good as TF. We certainly needed such large studies. However there 
are many concerns;  
 
1) The manuscript needs a substantial editing for the language. I counted 16 "reflex" 
inste ad of "reflux" in the text.  
 
2) The biggest surprise from my side is GERD -related death concept. 6/226 patients 
were death due to serious complications of GERD. I have never seen any GERD -related 
death unless there would be some procedure -related complicat ions or Barrett -related cancer. I 
would like to know  the reasons of mortality, whether procedure -related or other reasons 
which should be explained anyway. Even though this is a retrospective analysis, if authors 
could perform all the procedures one year after the procedure, they should also collect the 
mortalities. According to the comments above "Endpoint event was the death of patients due 
to GERD -related complications" should be re -evaluated and discussed.  
 
3) Another poor prognosis criteria was "chron ic pain", what kind of pain referred here?  
 
4) While mentioning GERD relapse, I suggest to give the normalization values and 
numbers of patients after 12 mos according to the pH monitoring. "Relapse" is mentioned 
onşy in a table table but I believe it is th e primary end point.  
 
5) Stretta procedure was not clearly defined (This catheter was advanced for 0.5 cm to 
repeat the process over the area 2 cm above and 1.5 cm below the squamo -columnar junction) 
but as far as I understood, only 4 applications were per formed within the esophagus. Under 
the regular conditions (except Sleeve and some other rare situations), nearly all centers 
perform with 14 applications, 8 esophagus + 6 cardia. Is it possible to give more details? If 
authors really have performed with 4 localizations only, this results are even more interesting. 
Because they achieved a non -inferiority data with less applications.  
 
6) What kind of surgery performed; open or laparoscopic? It is not mentioned in the 
text. If it is open surgery, is it possible  that operated patients are less happy because of the 
problems related with open surgery compared to laparoscopic?  
 
7) What is the reason of stopping medications before the procedure or exclude the 
cases? It is not suggested anywhere. It also makes sense to  perform both procedures on -PPI. 
By the way PPIs are acid -inhibitors not acid makings, should be corrected (Medications such 
as anti -cholinesterase drugs and acid -making agents that may affect esophageal motor 
function and secretion of gastric acid were di scontinued 7 days before the assessment.)  
 
8) One of the inclusion criteria was "foreign body sensation in the throat", this 
sentence in the text was also linked a case report in pub -med (when click on the sentence). 
This is not a GERD symptom by itself nor  it is an indication or important for the typical 
cases. Would you like to comment?  
 
9) Stretta catheters have been producing by non -Chinese companies (owner keeps 
changing) however authors mentioned that radiofrequency instrument is from Kanglian 
Medical E quipment Co., Ltd., Beijing. Could you please clarify? Catheters and generator are 
from different companies?  
 
10) It is mentioned in the text that "LES pressure was measured using XDJ -S8S 
Gastrointestinal Pressure Meter (Kelly Photoelectrics Technology Co.,  Ltd., Hefei, China)". 
Is this an esophageal motility system? If yes, please provide the details.  
 
11) Did esophageal motility perform before the procedure and before the pH probe 
insertion?  
 
12) This result is interesting "two parameters. The DeMeester scor e at 12 month after 
surgery was higher in the SRF group than that in the TF group, while the LES pressure was 
the opposite, suggesting that SRF is more effective to increase the esophageal pH and reduce 
the LES pressure in GERD patients." Is it possible to  speculate about the possible reasons? 
Also the sentence should be corrected.  
 
13) The term "gastroscopic endoscopy" should be corrected  
 
14) I suggest to change the title, drop "therapeutic"  
 
15) I could not understand the table 4 because it is in a bad shape following pdf.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported  by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend 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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declara tion of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from 
an organisation that may in any way gain or los e 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 t hat 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 s alary 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 compet ing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name 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 available under an Open Access C reative 
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 not be published.  
 
I agree to the open peer review policy of the journal  
assistant