Title: The important role of whole-process Computed Tomography guidance for percutaneous
gastrostomy in esophageal cancer patients who are unsuitable for or have had unsuccessful
attempts with endoscopic and fluoroscopic gastrostomy
Version: 3 Date: 05 Oct 2023
Reviewer's report:
Dear authors,
This is indeed a very good and novel study and you have done a good job in clarification of
ambiguities.  I still have an objection, which I hope you can explain or correct. In the discussion,
you have mentioned "In our study, one patient underwent 21G anterior lobe needle puncture
into the stomach cavity behind the left lobe of the liver", what does that mean? Anterior lobe
needle puncture of what into the stomach cavity? Did that involve liver puncture?
In addition, I would still disagree,  where you are suggesting the liver puncture through and
through to access stomach, even if that is with 21 gauged needle.  Unfortunately, he reference
that  has been put for it, is of a liver biopsy with 21 gauged needle. That is totally different,
because liver is highly vascular and in patient with advanced  malignancy, there is many a
times an element of low grade DIC. Where in case of liver biopsy, there still is surrounding
liver parenchyma to exert pressure and stop bleeding, this is not effective in through and
through puncture and can result in catastrophic bleeding. I suggest either you should remove this
dangerous suggestion, or provide an adequate reference where it has been demonstrated to be
safe, rather than assumption without any solid safety proof. Patient's death have occurred even
with liver biopsy only as well. So, there should be a concrete justification before suggesting this
to the medical community.
Regards.
Title: The important role of whole-process Computed Tomography guidance for percutaneous
gastrostomy in esophageal cancer patients who are unsuitable for or have had unsuccessful
attempts with endoscopic and fluoroscopic gastrostomy
Version: 3 Date: 05 Oct 2023
Reviewer's report:
Dear authors,
This is indeed a very good and novel study and you have done a good job in clarification of
ambiguities.  I still have an objection, which I hope you can explain or correct. In the discussion,
you have mentioned "In our study, one patient underwent 21G anterior lobe needle puncture
into the stomach cavity behind the left lobe of the liver", what does that mean? Anterior lobe
needle puncture of what into the stomach cavity? Did that involve liver puncture?
In addition, I would still disagree,  where you are suggesting the liver puncture through and
through to access stomach, even if that is with 21 gauged needle.  Unfortunately, he reference
that  has been put for it, is of a liver biopsy with 21 gauged needle. That is totally different,
because liver is highly vascular and in patient with advanced  malignancy, there is many a
times an element of low grade DIC. Where in case of liver biopsy, there still is surrounding
liver parenchyma to exert pressure and stop bleeding, this is not effective in through and
through puncture and can result in catastrophic bleeding. I suggest either you should remove this
dangerous suggestion, or provide an adequate reference where it has been demonstrated to be
safe, rather than assumption without any solid safety proof. Patient's death have occurred even
with liver biopsy only as well. So, there should be a concrete justification before suggesting this
to the medical community.
Regards.
Please review this paper.
user
Title: The important role of whole-process Computed Tomography guidance for percutaneous
gastrostomy in esophageal cancer patients who are unsuitable for or have had unsuccessful
attempts with endoscopic and fluoroscopic gastrostomy
Version: 3 Date: 05 Oct 2023
Reviewer's report:
Dear authors,
This is indeed a very good and novel study and you have done a good job in clarification of
ambiguities.  I still have an objection, which I hope you can explain or correct. In the discussion,
you have mentioned "In our study, one patient underwent 21G anterior lobe needle puncture
into the stomach cavity behind the left lobe of the liver", what does that mean? Anterior lobe
needle puncture of what into the stomach cavity? Did that involve liver puncture?
In addition, I would still disagree,  where you are suggesting the liver puncture through and
through to access stomach, even if that is with 21 gauged needle.  Unfortunately, he reference
that  has been put for it, is of a liver biopsy with 21 gauged needle. That is totally different,
because liver is highly vascular and in patient with advanced  malignancy, there is many a
times an element of low grade DIC. Where in case of liver biopsy, there still is surrounding
liver parenchyma to exert pressure and stop bleeding, this is not effective in through and
through puncture and can result in catastrophic bleeding. I suggest either you should remove this
dangerous suggestion, or provide an adequate reference where it has been demonstrated to be
safe, rather than assumption without any solid safety proof. Patient's death have occurred even
with liver biopsy only as well. So, there should be a concrete justification before suggesting this
to the medical community.
Regards.
assistant