Reviewer ’s report  
 
Title: The role of endoscopic dilation and stents in refractory benign esophageal strictures: a 
retrospective analysis.  
 
Version: 0 Date: 14 Oct 2018  
 
Reviewer: Aron Vincze  
 
Reviewer's report:  
 
The authors performed a retrospective cohort study to compare two management options of 
refractory benign esophageal strictures (RBES), dilations alone or with fully covered self -
expanding stent placement. They f ound in 75 patients that a dysphagia free period after stenting 
was shorter than after dilatation alone. On top of that stenting caused more adverse events. Some 
etiologies, e.g., post -surgical strictures might be more difficult to manage than other types of 
narrowing based on their data.  
The paper is generally well -written, easy to follow, the use of the English language is acceptable. 
However, there are some concerns about the data that should be clarified before publication.  
 
Major points:  
1) The autho rs included 3 achalasia patients in the cohort, however, they require a different 
approach and management. An analysis without these patients should be carried out to ensure 
a more homogeneous cohort. The mixed etiology group also consists of 3 patients, b ut not 
further information is given about the nature of the stenosis. This also should be clarified, or 
better to leave out these patients from the analysis.  
 
2) No information is given about the final diameter reached after each dilatation session, and 
also the diameter of stents were used should be clarified. The length of stenting had a great 
variance (between 7 to 67 days), therefore this group of patient was rather inhomogeneous. 
The short duration of stenting might explain the worse outcome in this gr oup, this needs 
further explanation.  
 
3) The group treated with dilatation and stent also might involve patient with more difficult to 
treat stenosis (e.g., smaller diameter after dilatation, longer stenosis, more previous 
dilatations) but this was not ana lyzed.  
 
 
Minor points:  
1) The results of recently published cohorts with benign esophageal stenosis would need to be 
discussed and compared (e.g., Repici A et al, Natural history and management of refractory 
benign esophageal strictures, Gastrointestinal En doscopy (2016), doi: 
10.1016/j.gie.2016.01.053., Walter D et al, Dilation or biodegradable stent placement for 
recurrent benign esophageal strictures: a randomized controlled trial. Endoscopy. 2018 Jun 8. 
doi: 10.1055/a -0602 -4169.)  
 
2) Did you use any inter vention to prevent recurrence, other than stenting (e.g., incision, 
intralesional steroid)?  
 
3) Page 7, line 50: Rephrase: Endoscopic treatment failure was achieved in 29 (38.7%) patients 
/ better to say experienced rather than achieved.  
 
4) Page 7, line 5 1: In 27 (62.5%) patients, the end of follow -up was coincident with the last 
endoscopic treatment - what was the length of dysphasia -free period in these patients? The 
percentage (62.5%) does not seem correct, how was it calculated?  
 
5) Page 8, line 11: All  the patients instead of The all patients  
 
6) Page 8, line 19: incomplete sentence  
 
7) The dilation time is not defined, the statement in Discussion therefore is not clear (page 8, 
line 49).  
 
8) The reference numbering in the text should be separated when m ore than one reference is 
given.  
 
9) Spelling errors: Savary (page 5, line 40)  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in  your comments to the authors.  
 
No 
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional sta tistical 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 t he 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 organisat ion 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 the  
manuscript?  
 
4. Have you received reimbursemen ts, 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 t his 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 o f 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 understand 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: The role of endoscopic dilation and stents in refractory benign esophageal strictures: a 
retrospective analysis.  
 
Version: 0 Date: 14 Oct 2018  
 
Reviewer: Aron Vincze  
 
Reviewer's report:  
 
The authors performed a retrospective cohort study to compare two management options of 
refractory benign esophageal strictures (RBES), dilations alone or with fully covered self -
expanding stent placement. They f ound in 75 patients that a dysphagia free period after stenting 
was shorter than after dilatation alone. On top of that stenting caused more adverse events. Some 
etiologies, e.g., post -surgical strictures might be more difficult to manage than other types of 
narrowing based on their data.  
The paper is generally well -written, easy to follow, the use of the English language is acceptable. 
However, there are some concerns about the data that should be clarified before publication.  
 
Major points:  
1) The autho rs included 3 achalasia patients in the cohort, however, they require a different 
approach and management. An analysis without these patients should be carried out to ensure 
a more homogeneous cohort. The mixed etiology group also consists of 3 patients, b ut not 
further information is given about the nature of the stenosis. This also should be clarified, or 
better to leave out these patients from the analysis.  
 
2) No information is given about the final diameter reached after each dilatation session, and 
also the diameter of stents were used should be clarified. The length of stenting had a great 
variance (between 7 to 67 days), therefore this group of patient was rather inhomogeneous. 
The short duration of stenting might explain the worse outcome in this gr oup, this needs 
further explanation.  
 
3) The group treated with dilatation and stent also might involve patient with more difficult to 
treat stenosis (e.g., smaller diameter after dilatation, longer stenosis, more previous 
dilatations) but this was not ana lyzed.  
 
 
Minor points:  
1) The results of recently published cohorts with benign esophageal stenosis would need to be 
discussed and compared (e.g., Repici A et al, Natural history and management of refractory 
benign esophageal strictures, Gastrointestinal En doscopy (2016), doi: 
10.1016/j.gie.2016.01.053., Walter D et al, Dilation or biodegradable stent placement for 
recurrent benign esophageal strictures: a randomized controlled trial. Endoscopy. 2018 Jun 8. 
doi: 10.1055/a -0602 -4169.)  
 
2) Did you use any inter vention to prevent recurrence, other than stenting (e.g., incision, 
intralesional steroid)?  
 
3) Page 7, line 50: Rephrase: Endoscopic treatment failure was achieved in 29 (38.7%) patients 
/ better to say experienced rather than achieved.  
 
4) Page 7, line 5 1: In 27 (62.5%) patients, the end of follow -up was coincident with the last 
endoscopic treatment - what was the length of dysphasia -free period in these patients? The 
percentage (62.5%) does not seem correct, how was it calculated?  
 
5) Page 8, line 11: All  the patients instead of The all patients  
 
6) Page 8, line 19: incomplete sentence  
 
7) The dilation time is not defined, the statement in Discussion therefore is not clear (page 8, 
line 49).  
 
8) The reference numbering in the text should be separated when m ore than one reference is 
given.  
 
9) Spelling errors: Savary (page 5, line 40)  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in  your comments to the authors.  
 
No 
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional sta tistical 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 t he 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 organisat ion 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 the  
manuscript?  
 
4. Have you received reimbursemen ts, 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 t his 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 o f 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 understand 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: The role of endoscopic dilation and stents in refractory benign esophageal strictures: a 
retrospective analysis.  
 
Version: 0 Date: 14 Oct 2018  
 
Reviewer: Aron Vincze  
 
Reviewer's report:  
 
The authors performed a retrospective cohort study to compare two management options of 
refractory benign esophageal strictures (RBES), dilations alone or with fully covered self -
expanding stent placement. They f ound in 75 patients that a dysphagia free period after stenting 
was shorter than after dilatation alone. On top of that stenting caused more adverse events. Some 
etiologies, e.g., post -surgical strictures might be more difficult to manage than other types of 
narrowing based on their data.  
The paper is generally well -written, easy to follow, the use of the English language is acceptable. 
However, there are some concerns about the data that should be clarified before publication.  
 
Major points:  
1) The autho rs included 3 achalasia patients in the cohort, however, they require a different 
approach and management. An analysis without these patients should be carried out to ensure 
a more homogeneous cohort. The mixed etiology group also consists of 3 patients, b ut not 
further information is given about the nature of the stenosis. This also should be clarified, or 
better to leave out these patients from the analysis.  
 
2) No information is given about the final diameter reached after each dilatation session, and 
also the diameter of stents were used should be clarified. The length of stenting had a great 
variance (between 7 to 67 days), therefore this group of patient was rather inhomogeneous. 
The short duration of stenting might explain the worse outcome in this gr oup, this needs 
further explanation.  
 
3) The group treated with dilatation and stent also might involve patient with more difficult to 
treat stenosis (e.g., smaller diameter after dilatation, longer stenosis, more previous 
dilatations) but this was not ana lyzed.  
 
 
Minor points:  
1) The results of recently published cohorts with benign esophageal stenosis would need to be 
discussed and compared (e.g., Repici A et al, Natural history and management of refractory 
benign esophageal strictures, Gastrointestinal En doscopy (2016), doi: 
10.1016/j.gie.2016.01.053., Walter D et al, Dilation or biodegradable stent placement for 
recurrent benign esophageal strictures: a randomized controlled trial. Endoscopy. 2018 Jun 8. 
doi: 10.1055/a -0602 -4169.)  
 
2) Did you use any inter vention to prevent recurrence, other than stenting (e.g., incision, 
intralesional steroid)?  
 
3) Page 7, line 50: Rephrase: Endoscopic treatment failure was achieved in 29 (38.7%) patients 
/ better to say experienced rather than achieved.  
 
4) Page 7, line 5 1: In 27 (62.5%) patients, the end of follow -up was coincident with the last 
endoscopic treatment - what was the length of dysphasia -free period in these patients? The 
percentage (62.5%) does not seem correct, how was it calculated?  
 
5) Page 8, line 11: All  the patients instead of The all patients  
 
6) Page 8, line 19: incomplete sentence  
 
7) The dilation time is not defined, the statement in Discussion therefore is not clear (page 8, 
line 49).  
 
8) The reference numbering in the text should be separated when m ore than one reference is 
given.  
 
9) Spelling errors: Savary (page 5, line 40)  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in  your comments to the authors.  
 
No 
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional sta tistical 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 t he 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 organisat ion 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 the  
manuscript?  
 
4. Have you received reimbursemen ts, 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 t his 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 o f 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 understand 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