Reviewer's report
Title:Safety of pull-type and push-type percutaneous endoscopic gastrostomy
tubes in oncology patients: a retrospective analysis
Version: 1Date:24 November 2010
Reviewer: Shinji Nishiwaki
Reviewer's report:
This manuscript compared the complications and outcomes of PEG in patients
with head/neck or esophageal malignancies using two different techniques, i.e.,
“push” or “pull” type as per the authors’ words. If the authors are evaluating the
two methods, the patients’ backgrounds should be clarified in more detail. There
were several major complications including perforation, bleeding, and sepsis.
Please describe in more detail the circumstances and causes of the major
complications, and how these complications might be prevented or minimized.
Major Compulsory Revisions
#1. The term “push-type PEG” commonly refers to the Sachs-Vine technique,
also known as the “push technique”. The “push technique” is similar to “pull
technique” in that the bumper is placed through the mouth. The method stated as
“push-type PEG” in the manuscript should be referred to as the “introducer
technique” or “introducer method” in general, which was described in the
references # 8, 9 and 17.
#2. The authors compared the short term complications and outcomes of PEG
using the pull- and introducer methods. However, they did not mention whether
the backgrounds of the two groups were comparable. It has been reported that
outcomes and complications are dependent on the nutritional status (e.g. serum
albumin concentration) and severity of the comorbid diseases. If these
backgrounds were significantly different between the groups, it is problematic to
conclude that the conventional pull-type PEG is recommended for patients with
head/neck or esophageal malignancies. The choice of the introducer method was
for patients with high-grade malignant stenosis, possibly indicating that the more
advanced-stage patients undergo the introducer method rather than the
pull-method. It is necessary to describe at least the serum albumin levels and
performance status or the clinical stages of the cancer in Table 1 or in the body
of the manuscript.
#3. There were some severe complications especially in the introducer method
group. Please describe in more detail in the Results section regarding the
complications, especially in case of perforation, bleeding and sepsis. Did a
perforation develop at placement or from accidental dislodgment before the
maturation of the fistula (most frequent reason in general)? Where was the
location (e.g. the gastorpexy site or PEG tube insertion site) of the perforation?
What were the causes of bleeding and sepsis? Furthermore, it is preferable to
describe how to prevent these complications in the Discussion.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Safety of pull-type and push-type percutaneous endoscopic gastrostomy
tubes in oncology patients: a retrospective analysis
Version: 1Date:24 November 2010
Reviewer: Shinji Nishiwaki
Reviewer's report:
This manuscript compared the complications and outcomes of PEG in patients
with head/neck or esophageal malignancies using two different techniques, i.e.,
“push” or “pull” type as per the authors’ words. If the authors are evaluating the
two methods, the patients’ backgrounds should be clarified in more detail. There
were several major complications including perforation, bleeding, and sepsis.
Please describe in more detail the circumstances and causes of the major
complications, and how these complications might be prevented or minimized.
Major Compulsory Revisions
#1. The term “push-type PEG” commonly refers to the Sachs-Vine technique,
also known as the “push technique”. The “push technique” is similar to “pull
technique” in that the bumper is placed through the mouth. The method stated as
“push-type PEG” in the manuscript should be referred to as the “introducer
technique” or “introducer method” in general, which was described in the
references # 8, 9 and 17.
#2. The authors compared the short term complications and outcomes of PEG
using the pull- and introducer methods. However, they did not mention whether
the backgrounds of the two groups were comparable. It has been reported that
outcomes and complications are dependent on the nutritional status (e.g. serum
albumin concentration) and severity of the comorbid diseases. If these
backgrounds were significantly different between the groups, it is problematic to
conclude that the conventional pull-type PEG is recommended for patients with
head/neck or esophageal malignancies. The choice of the introducer method was
for patients with high-grade malignant stenosis, possibly indicating that the more
advanced-stage patients undergo the introducer method rather than the
pull-method. It is necessary to describe at least the serum albumin levels and
performance status or the clinical stages of the cancer in Table 1 or in the body
of the manuscript.
#3. There were some severe complications especially in the introducer method
group. Please describe in more detail in the Results section regarding the
complications, especially in case of perforation, bleeding and sepsis. Did a
perforation develop at placement or from accidental dislodgment before the
maturation of the fistula (most frequent reason in general)? Where was the
location (e.g. the gastorpexy site or PEG tube insertion site) of the perforation?
What were the causes of bleeding and sepsis? Furthermore, it is preferable to
describe how to prevent these complications in the Discussion.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Safety of pull-type and push-type percutaneous endoscopic gastrostomy
tubes in oncology patients: a retrospective analysis
Version: 1Date:24 November 2010
Reviewer: Shinji Nishiwaki
Reviewer's report:
This manuscript compared the complications and outcomes of PEG in patients
with head/neck or esophageal malignancies using two different techniques, i.e.,
“push” or “pull” type as per the authors’ words. If the authors are evaluating the
two methods, the patients’ backgrounds should be clarified in more detail. There
were several major complications including perforation, bleeding, and sepsis.
Please describe in more detail the circumstances and causes of the major
complications, and how these complications might be prevented or minimized.
Major Compulsory Revisions
#1. The term “push-type PEG” commonly refers to the Sachs-Vine technique,
also known as the “push technique”. The “push technique” is similar to “pull
technique” in that the bumper is placed through the mouth. The method stated as
“push-type PEG” in the manuscript should be referred to as the “introducer
technique” or “introducer method” in general, which was described in the
references # 8, 9 and 17.
#2. The authors compared the short term complications and outcomes of PEG
using the pull- and introducer methods. However, they did not mention whether
the backgrounds of the two groups were comparable. It has been reported that
outcomes and complications are dependent on the nutritional status (e.g. serum
albumin concentration) and severity of the comorbid diseases. If these
backgrounds were significantly different between the groups, it is problematic to
conclude that the conventional pull-type PEG is recommended for patients with
head/neck or esophageal malignancies. The choice of the introducer method was
for patients with high-grade malignant stenosis, possibly indicating that the more
advanced-stage patients undergo the introducer method rather than the
pull-method. It is necessary to describe at least the serum albumin levels and
performance status or the clinical stages of the cancer in Table 1 or in the body
of the manuscript.
#3. There were some severe complications especially in the introducer method
group. Please describe in more detail in the Results section regarding the
complications, especially in case of perforation, bleeding and sepsis. Did a
perforation develop at placement or from accidental dislodgment before the
maturation of the fistula (most frequent reason in general)? Where was the
location (e.g. the gastorpexy site or PEG tube insertion site) of the perforation?
What were the causes of bleeding and sepsis? Furthermore, it is preferable to
describe how to prevent these complications in the Discussion.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
assistant