Reviewer ’s report  
 
Title:  Submucosal hematoma: a new distinctive sign during emergency upper digestive 
endoscopy for ammonia ingestion  
 
Version: 0 Date: 25 Dec 2017 
 
Reviewer:  Ibrahim  Uygun  
 
Reviewer’s report:  
 
Dear Author,  
 
This is an interesting manuscript that is encountered in adult submucosal hematoma with 
ammonia ingestion as a new distinctive sign. However; I would like to point out the following;  
 
1. Generally, the manuscript is good written, however it has some grammar and spell ing errors (P 
vaiue, etc..). So, the manuscript should be edited by medical manuscript edition service such as 
www.textcheck.com. English? American or British?  
 
2. "These endoscopies were done in the presence of the attendant surgeon if possible, …". What 
does it means? How many surgeon did the endoscopies? "due to inexperienced surgeon in 
esophageal surgery". What does it means? Who is he/she? The Author should clarify the 
surgeon/endoscopist? How many, specialty, ratio, etc, …?  
 
3. "Patients did not recei ve systematic antibiotics". What does it means? For all patients? Also 
for the patients with extended necrosis or perforation?  
 
4. "diet was followed for 6 weeks and a barium swallow was completed to assess stricture 
formation." It is very late. In the mai n text -book of pediatric surgery for 20 years and in the 
current literature, they recommended that the first esophageal balloon dilatation should be 
commenced earlier (at 10 -14 days after caustic ingestion) for the patients with dysphagia, 
because, "early dilation in patients suffering from oesophageal stricture after CSI improves 
treatment success". Not after 6 weeks.  
 
5. "the study predominantly included female (sex ratio=0.87)". What does sex ratio means? And 
what is 0,87? In the Table, 20 male, 23 femal e. Why the female patients count predominantly 
high? Is it very high? 23 vs 20?  
 
6. "Twenty -six (60.5%) patients underwent the first endoscopic follow -up in a median amount of 
time of 8 1-21 days following admission." What does it mean? Does it mean that  in the first 
day (1 -21), second endoscopy for control endoscopy in some cases? However, in the Method 
section, "A follow -up endoscopy at day 8 was completed for patients who had grade IIA to IIIA 
oesophago -gastric lesions." Which one was carried out? For 8 days starvation for all patients 
without drooling saliva and perforations is too long and not acceptable in the current modern 
treatment protocol.  
7. What is "clinical signs of severity"? Severity of clinical signs?  
 
8. The Conclusions in the Abstract and the Discussion sections are different. In the Discussion 
section, the Conclusion is not clear. In the Abstract, the conclusion is clear. However, they are 
excessive inference and contradictory. "Submucosal hematoma no t associated with increased risk 
for death or surgical resection." Where is the statistical comparison? In the contrary, in Table 2, 
death (13,3%) and stenosis (13,3%) were high in the submucal hematoma compared with no 
submucosal hematoma. "In case of sub mucosal hematoma, medical management is an acceptable 
option, even in presence of severe endoscopic lesions.". This is excessive inference and lack 
evidence. Some results are inevitable. How much bread, so much meatballs. Burn vs hematoma.  
 
9. "Moreover, i t was reported at each stage of endoscopic grading but in greater proportion in 
mild (IIB, IIIA) and severe (IIIB) endoscopic injuries in 33.3%, 13.3% and 20.0% respectively; 
P=0.02 (Table 2)". What is the p values for each grade? And also each line in the  Table 2?  
 
10. In the Method section, "absorbed" or "ingested"?  
 
11. "the management protocol was based on the findings of the initial endoscopic examination". 
This is not true. It was also based on sign and symptoms such as abdominal pain.  
 
12. The Discus sion section should be re -written. The other treatment protocol (including 
pediatric patients, because in this case series some cases is child) should be discussed. TPN, 
starvation, early treatment of the esophageal stricture with early balloon dilatation,  initial 
endoscopy for all patients, etc. should be discussed.  
 
13. Jejunostomy? How? Open, laparoscopic? Tube or nasojejunal feeding tube? They should be 
clarified.  
 
14. Finally, this prospective case series do not add much new insight into the already ex isting 
literature on the same subject and do not provide any very new knowledge to the readership.  
 
So, the manuscript should not be published in BMC Gastroenterology.  
 
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 manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests,  considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 th e 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary 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 competing 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 understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for 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 Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I und erstand that any comments 
which I do not wish to be included in my named report can be included 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:  Submucosal hematoma: a new distinctive sign during emergency upper digestive 
endoscopy for ammonia ingestion  
 
Version: 0 Date: 25 Dec 2017 
 
Reviewer:  Ibrahim  Uygun  
 
Reviewer’s report:  
 
Dear Author,  
 
This is an interesting manuscript that is encountered in adult submucosal hematoma with 
ammonia ingestion as a new distinctive sign. However; I would like to point out the following;  
 
1. Generally, the manuscript is good written, however it has some grammar and spell ing errors (P 
vaiue, etc..). So, the manuscript should be edited by medical manuscript edition service such as 
www.textcheck.com. English? American or British?  
 
2. "These endoscopies were done in the presence of the attendant surgeon if possible, …". What 
does it means? How many surgeon did the endoscopies? "due to inexperienced surgeon in 
esophageal surgery". What does it means? Who is he/she? The Author should clarify the 
surgeon/endoscopist? How many, specialty, ratio, etc, …?  
 
3. "Patients did not recei ve systematic antibiotics". What does it means? For all patients? Also 
for the patients with extended necrosis or perforation?  
 
4. "diet was followed for 6 weeks and a barium swallow was completed to assess stricture 
formation." It is very late. In the mai n text -book of pediatric surgery for 20 years and in the 
current literature, they recommended that the first esophageal balloon dilatation should be 
commenced earlier (at 10 -14 days after caustic ingestion) for the patients with dysphagia, 
because, "early dilation in patients suffering from oesophageal stricture after CSI improves 
treatment success". Not after 6 weeks.  
 
5. "the study predominantly included female (sex ratio=0.87)". What does sex ratio means? And 
what is 0,87? In the Table, 20 male, 23 femal e. Why the female patients count predominantly 
high? Is it very high? 23 vs 20?  
 
6. "Twenty -six (60.5%) patients underwent the first endoscopic follow -up in a median amount of 
time of 8 1-21 days following admission." What does it mean? Does it mean that  in the first 
day (1 -21), second endoscopy for control endoscopy in some cases? However, in the Method 
section, "A follow -up endoscopy at day 8 was completed for patients who had grade IIA to IIIA 
oesophago -gastric lesions." Which one was carried out? For 8 days starvation for all patients 
without drooling saliva and perforations is too long and not acceptable in the current modern 
treatment protocol.  
7. What is "clinical signs of severity"? Severity of clinical signs?  
 
8. The Conclusions in the Abstract and the Discussion sections are different. In the Discussion 
section, the Conclusion is not clear. In the Abstract, the conclusion is clear. However, they are 
excessive inference and contradictory. "Submucosal hematoma no t associated with increased risk 
for death or surgical resection." Where is the statistical comparison? In the contrary, in Table 2, 
death (13,3%) and stenosis (13,3%) were high in the submucal hematoma compared with no 
submucosal hematoma. "In case of sub mucosal hematoma, medical management is an acceptable 
option, even in presence of severe endoscopic lesions.". This is excessive inference and lack 
evidence. Some results are inevitable. How much bread, so much meatballs. Burn vs hematoma.  
 
9. "Moreover, i t was reported at each stage of endoscopic grading but in greater proportion in 
mild (IIB, IIIA) and severe (IIIB) endoscopic injuries in 33.3%, 13.3% and 20.0% respectively; 
P=0.02 (Table 2)". What is the p values for each grade? And also each line in the  Table 2?  
 
10. In the Method section, "absorbed" or "ingested"?  
 
11. "the management protocol was based on the findings of the initial endoscopic examination". 
This is not true. It was also based on sign and symptoms such as abdominal pain.  
 
12. The Discus sion section should be re -written. The other treatment protocol (including 
pediatric patients, because in this case series some cases is child) should be discussed. TPN, 
starvation, early treatment of the esophageal stricture with early balloon dilatation,  initial 
endoscopy for all patients, etc. should be discussed.  
 
13. Jejunostomy? How? Open, laparoscopic? Tube or nasojejunal feeding tube? They should be 
clarified.  
 
14. Finally, this prospective case series do not add much new insight into the already ex isting 
literature on the same subject and do not provide any very new knowledge to the readership.  
 
So, the manuscript should not be published in BMC Gastroenterology.  
 
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 manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests,  considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 th e 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary 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 competing 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 understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for 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 Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I und erstand that any comments 
which I do not wish to be included in my named report can be included 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:  Submucosal hematoma: a new distinctive sign during emergency upper digestive 
endoscopy for ammonia ingestion  
 
Version: 0 Date: 25 Dec 2017 
 
Reviewer:  Ibrahim  Uygun  
 
Reviewer’s report:  
 
Dear Author,  
 
This is an interesting manuscript that is encountered in adult submucosal hematoma with 
ammonia ingestion as a new distinctive sign. However; I would like to point out the following;  
 
1. Generally, the manuscript is good written, however it has some grammar and spell ing errors (P 
vaiue, etc..). So, the manuscript should be edited by medical manuscript edition service such as 
www.textcheck.com. English? American or British?  
 
2. "These endoscopies were done in the presence of the attendant surgeon if possible, …". What 
does it means? How many surgeon did the endoscopies? "due to inexperienced surgeon in 
esophageal surgery". What does it means? Who is he/she? The Author should clarify the 
surgeon/endoscopist? How many, specialty, ratio, etc, …?  
 
3. "Patients did not recei ve systematic antibiotics". What does it means? For all patients? Also 
for the patients with extended necrosis or perforation?  
 
4. "diet was followed for 6 weeks and a barium swallow was completed to assess stricture 
formation." It is very late. In the mai n text -book of pediatric surgery for 20 years and in the 
current literature, they recommended that the first esophageal balloon dilatation should be 
commenced earlier (at 10 -14 days after caustic ingestion) for the patients with dysphagia, 
because, "early dilation in patients suffering from oesophageal stricture after CSI improves 
treatment success". Not after 6 weeks.  
 
5. "the study predominantly included female (sex ratio=0.87)". What does sex ratio means? And 
what is 0,87? In the Table, 20 male, 23 femal e. Why the female patients count predominantly 
high? Is it very high? 23 vs 20?  
 
6. "Twenty -six (60.5%) patients underwent the first endoscopic follow -up in a median amount of 
time of 8 1-21 days following admission." What does it mean? Does it mean that  in the first 
day (1 -21), second endoscopy for control endoscopy in some cases? However, in the Method 
section, "A follow -up endoscopy at day 8 was completed for patients who had grade IIA to IIIA 
oesophago -gastric lesions." Which one was carried out? For 8 days starvation for all patients 
without drooling saliva and perforations is too long and not acceptable in the current modern 
treatment protocol.  
7. What is "clinical signs of severity"? Severity of clinical signs?  
 
8. The Conclusions in the Abstract and the Discussion sections are different. In the Discussion 
section, the Conclusion is not clear. In the Abstract, the conclusion is clear. However, they are 
excessive inference and contradictory. "Submucosal hematoma no t associated with increased risk 
for death or surgical resection." Where is the statistical comparison? In the contrary, in Table 2, 
death (13,3%) and stenosis (13,3%) were high in the submucal hematoma compared with no 
submucosal hematoma. "In case of sub mucosal hematoma, medical management is an acceptable 
option, even in presence of severe endoscopic lesions.". This is excessive inference and lack 
evidence. Some results are inevitable. How much bread, so much meatballs. Burn vs hematoma.  
 
9. "Moreover, i t was reported at each stage of endoscopic grading but in greater proportion in 
mild (IIB, IIIA) and severe (IIIB) endoscopic injuries in 33.3%, 13.3% and 20.0% respectively; 
P=0.02 (Table 2)". What is the p values for each grade? And also each line in the  Table 2?  
 
10. In the Method section, "absorbed" or "ingested"?  
 
11. "the management protocol was based on the findings of the initial endoscopic examination". 
This is not true. It was also based on sign and symptoms such as abdominal pain.  
 
12. The Discus sion section should be re -written. The other treatment protocol (including 
pediatric patients, because in this case series some cases is child) should be discussed. TPN, 
starvation, early treatment of the esophageal stricture with early balloon dilatation,  initial 
endoscopy for all patients, etc. should be discussed.  
 
13. Jejunostomy? How? Open, laparoscopic? Tube or nasojejunal feeding tube? They should be 
clarified.  
 
14. Finally, this prospective case series do not add much new insight into the already ex isting 
literature on the same subject and do not provide any very new knowledge to the readership.  
 
So, the manuscript should not be published in BMC Gastroenterology.  
 
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 manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests,  considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 th e 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary 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 competing 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 understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for 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 Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I und erstand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
I agree to the open peer review policy of the journal  
assistant