Title: Risk factors for refractory enterocutaneous fistula following button jejunostomy removal
and its treatment using a novel extraperitoneal approach in patients with oesophageal cancer:
A retrospective cohort study
Version: 1 Date: 18 Sep 2022
Reviewer's report:
Thank you for my opportunity to review this manuscript “Risk factors for refractory
enterocutaneous fistula following button jejunostomy removal and its treatment using a novel
extraperitoneal approach in patients with esophageal cancer: A retrospective cohort study”.
The authors have done a retrospective cohort study including 47 patients who underwent button
jejunostomy removal for esophageal cancer. Refractory enterocutaneous fistula (REF) occurred
in 15 patients. The fistulas were closed with a novel extraperitoneal approach (EPA).
REF was defined as a condition in which spontaneous closure of the fistula was not achieved.
However, a time for when the fistula should be healed has not been specified. Most fistulas after
tube placement will heal spontaneously given some time. It is therefore important to be patient,
even though patients and relatives often can be anxious to have the fistula repaired as soon as
possible. Up to 95 % of fistulas that heal without intervention will do so within four to five
weeks. After this period of time, it may therefore be reasonable to say a fistula is refractory.
I believe that the novel extraperitoneal approach (EPA) is a good method for REF closure.
However, 31,9% REF is a high number, and more effort should be put into preventing REF.
The results of the study should perhaps lead to the conclusion that button jejunostomy should be
avoided in some patients. I would like to see some comments about it in the discussion section.
Title: Risk factors for refractory enterocutaneous fistula following button jejunostomy removal
and its treatment using a novel extraperitoneal approach in patients with oesophageal cancer:
A retrospective cohort study
Version: 1 Date: 18 Sep 2022
Reviewer's report:
Thank you for my opportunity to review this manuscript “Risk factors for refractory
enterocutaneous fistula following button jejunostomy removal and its treatment using a novel
extraperitoneal approach in patients with esophageal cancer: A retrospective cohort study”.
The authors have done a retrospective cohort study including 47 patients who underwent button
jejunostomy removal for esophageal cancer. Refractory enterocutaneous fistula (REF) occurred
in 15 patients. The fistulas were closed with a novel extraperitoneal approach (EPA).
REF was defined as a condition in which spontaneous closure of the fistula was not achieved.
However, a time for when the fistula should be healed has not been specified. Most fistulas after
tube placement will heal spontaneously given some time. It is therefore important to be patient,
even though patients and relatives often can be anxious to have the fistula repaired as soon as
possible. Up to 95 % of fistulas that heal without intervention will do so within four to five
weeks. After this period of time, it may therefore be reasonable to say a fistula is refractory.
I believe that the novel extraperitoneal approach (EPA) is a good method for REF closure.
However, 31,9% REF is a high number, and more effort should be put into preventing REF.
The results of the study should perhaps lead to the conclusion that button jejunostomy should be
avoided in some patients. I would like to see some comments about it in the discussion section.
Please review this paper.
user
Title: Risk factors for refractory enterocutaneous fistula following button jejunostomy removal
and its treatment using a novel extraperitoneal approach in patients with oesophageal cancer:
A retrospective cohort study
Version: 1 Date: 18 Sep 2022
Reviewer's report:
Thank you for my opportunity to review this manuscript “Risk factors for refractory
enterocutaneous fistula following button jejunostomy removal and its treatment using a novel
extraperitoneal approach in patients with esophageal cancer: A retrospective cohort study”.
The authors have done a retrospective cohort study including 47 patients who underwent button
jejunostomy removal for esophageal cancer. Refractory enterocutaneous fistula (REF) occurred
in 15 patients. The fistulas were closed with a novel extraperitoneal approach (EPA).
REF was defined as a condition in which spontaneous closure of the fistula was not achieved.
However, a time for when the fistula should be healed has not been specified. Most fistulas after
tube placement will heal spontaneously given some time. It is therefore important to be patient,
even though patients and relatives often can be anxious to have the fistula repaired as soon as
possible. Up to 95 % of fistulas that heal without intervention will do so within four to five
weeks. After this period of time, it may therefore be reasonable to say a fistula is refractory.
I believe that the novel extraperitoneal approach (EPA) is a good method for REF closure.
However, 31,9% REF is a high number, and more effort should be put into preventing REF.
The results of the study should perhaps lead to the conclusion that button jejunostomy should be
avoided in some patients. I would like to see some comments about it in the discussion section.
assistant