Title: Incidence and risk factors of nasogastric feeding intolerance in moderately-severe to
severe acute pancreatitis
Version: 1 Date: 25 Mar 2022
Reviewer's report:
Dear Editor,
Thank you for giving me the opportunity to review the manuscript entitled "Incidence and risk
factors of nasogastric feeding intolerance in moderate-severe to severe acute pancreatitis" for
your journal.
In this retrospective study the authors assessed 93 patients with moderate-severe to severe AP
and evaluated the incidence and risk factors for nasogastric feeding intolerance.
Please find below my comments:
1. The technique used to place the NJ tube in the med-distal jejunum should be explained. It
seems to the reviewer that the normal position of the NJ tube should be the proximal jejunum,
aiming to pass the ligament of Treitz.
2. The definition of GFI is provided twice in the manuscript and this should be amended.
3. The definition of "respiratory failure" is not provided in the manuscript. This should be
amended, while description of this outcome was assessed should also be made available (time
of respiratory failure regarding admission, etc..).
4. The univariable analysis included the following variables: age, sex, BMI, etiology of
pancreatitis, presence of respiratory failure and APACHE II score. The authors should explain
why other organ failures were not chosen to be included in the analysis model. Moreover, the
APACHE II score already includes a part of what the authors describe as "respiratory failure"
since both the respiratory rate and the FiO2 are used to calculate the score. Hoe can the authors
be sure that there is no interaction between the two variables? Did they check for multiple
interactions and did they assessed the appropriateness of their model?
5. From a statistical point of view this type of analysis with the relative small number of patients
is not suitable to perform a multivariable analysis. Moreover, the two groups differed in several
baseline characteristics. For exemple patients in GFI group presented higher rates of respiratory
failure, AKI and APACHE, meaning that more severe patients may be associated with higher
rates of GFI. In order to avoid this type of uneven distribution I believe the authors should either
undergo another type of analysis (e.g. propensity score match) or simply reorientate their paper
reporting the incidence of GFI among patients with moderate-sever to severe AP.
Title: Incidence and risk factors of nasogastric feeding intolerance in moderately-severe to
severe acute pancreatitis
Version: 1 Date: 25 Mar 2022
Reviewer's report:
Dear Editor,
Thank you for giving me the opportunity to review the manuscript entitled "Incidence and risk
factors of nasogastric feeding intolerance in moderate-severe to severe acute pancreatitis" for
your journal.
In this retrospective study the authors assessed 93 patients with moderate-severe to severe AP
and evaluated the incidence and risk factors for nasogastric feeding intolerance.
Please find below my comments:
1. The technique used to place the NJ tube in the med-distal jejunum should be explained. It
seems to the reviewer that the normal position of the NJ tube should be the proximal jejunum,
aiming to pass the ligament of Treitz.
2. The definition of GFI is provided twice in the manuscript and this should be amended.
3. The definition of "respiratory failure" is not provided in the manuscript. This should be
amended, while description of this outcome was assessed should also be made available (time
of respiratory failure regarding admission, etc..).
4. The univariable analysis included the following variables: age, sex, BMI, etiology of
pancreatitis, presence of respiratory failure and APACHE II score. The authors should explain
why other organ failures were not chosen to be included in the analysis model. Moreover, the
APACHE II score already includes a part of what the authors describe as "respiratory failure"
since both the respiratory rate and the FiO2 are used to calculate the score. Hoe can the authors
be sure that there is no interaction between the two variables? Did they check for multiple
interactions and did they assessed the appropriateness of their model?
5. From a statistical point of view this type of analysis with the relative small number of patients
is not suitable to perform a multivariable analysis. Moreover, the two groups differed in several
baseline characteristics. For exemple patients in GFI group presented higher rates of respiratory
failure, AKI and APACHE, meaning that more severe patients may be associated with higher
rates of GFI. In order to avoid this type of uneven distribution I believe the authors should either
undergo another type of analysis (e.g. propensity score match) or simply reorientate their paper
reporting the incidence of GFI among patients with moderate-sever to severe AP.
Please review this paper.
user
Title: Incidence and risk factors of nasogastric feeding intolerance in moderately-severe to
severe acute pancreatitis
Version: 1 Date: 25 Mar 2022
Reviewer's report:
Dear Editor,
Thank you for giving me the opportunity to review the manuscript entitled "Incidence and risk
factors of nasogastric feeding intolerance in moderate-severe to severe acute pancreatitis" for
your journal.
In this retrospective study the authors assessed 93 patients with moderate-severe to severe AP
and evaluated the incidence and risk factors for nasogastric feeding intolerance.
Please find below my comments:
1. The technique used to place the NJ tube in the med-distal jejunum should be explained. It
seems to the reviewer that the normal position of the NJ tube should be the proximal jejunum,
aiming to pass the ligament of Treitz.
2. The definition of GFI is provided twice in the manuscript and this should be amended.
3. The definition of "respiratory failure" is not provided in the manuscript. This should be
amended, while description of this outcome was assessed should also be made available (time
of respiratory failure regarding admission, etc..).
4. The univariable analysis included the following variables: age, sex, BMI, etiology of
pancreatitis, presence of respiratory failure and APACHE II score. The authors should explain
why other organ failures were not chosen to be included in the analysis model. Moreover, the
APACHE II score already includes a part of what the authors describe as "respiratory failure"
since both the respiratory rate and the FiO2 are used to calculate the score. Hoe can the authors
be sure that there is no interaction between the two variables? Did they check for multiple
interactions and did they assessed the appropriateness of their model?
5. From a statistical point of view this type of analysis with the relative small number of patients
is not suitable to perform a multivariable analysis. Moreover, the two groups differed in several
baseline characteristics. For exemple patients in GFI group presented higher rates of respiratory
failure, AKI and APACHE, meaning that more severe patients may be associated with higher
rates of GFI. In order to avoid this type of uneven distribution I believe the authors should either
undergo another type of analysis (e.g. propensity score match) or simply reorientate their paper
reporting the incidence of GFI among patients with moderate-sever to severe AP.
assistant