Reviewer’s report
Title: 
Vertical distance from navel as a risk factor for bowel obstruction
associated with feeding jejunostomy after esophagectomy : a retrospective
cohort study
Version: 
1 
Date: 
16 Aug 2020
Reviewer's report:
The authors present a retrospective review of 70 patients who underwent
'thoracoscopic' esophagectomy between March 2013 and December 2019 of
whom 6 patients developed bowel obstruction after feeding jejunostomy tube
placement (BOFJ). They found that the vertical distance between the umbilicus
and the j-tube site was the only significant factor that predicted BOFJ. I have
several questions and concerns about this manuscript.
1.) I am worried that you have a significant variable that you do not seem to
have taken into account--this is the fact that you changed the type of abdominal
mobilization you were using after the first two years--going from hand-assisted
to a more complete laparoscopic approach for the final 4 years. In doing this, you
changed the location of your incision to one in the upper abdomen to one closer
to the umbilicus. It seems pretty clear to this reader that in doing so you have
naturally changed the location of where the j-tube would most naturally lie--
lower in the latter half of your experience. So, please tell us how many patients
were in each group (HALS vs. laparoscopic) and the BOFJ--did these all occur
in the patients undergoing HALS? This may be difficult to evaluate statistically
because there are so few patients with bowel obstruction. 
2.) I think you need to better define your terminology for esophagectomy. You
state it is a thoracoscopic esophagectomy but this is only part of the procedure
you describe in your methods. It is really what we would call a 3-hole
esophagectomy with an abdominal component and an anastomosis in the neck.
3.) You had 3 patients that had 3 or more episodes (I think) of BOFJ--one
wonders why these obstructions were not treated more aggressively with FJ
removal after one or two bouts.
4.) Why did your patients undergo neoadjuvant chemotherapy as opposed to
chemoradiation which is standard of care based on CROSS trial results.
5.) All of your patients appear to have had an abdominal CT scan performed
within one month after the primary operation by which you measured the
vertical distance--Is this CT scan part of your normal routine? Why a 30 day CT
scan--is it part of some sort of protocol?
Minor issues:
There is a sentence in the results section of the abstract that does not make
sense--"Conducting univariate analysis, logistic regression analysis showed...." Is
is logistic regression or univariate analysis?
Your paragraphs should be indented to signify a new paragraph
In your methods section on page 4, you have several one sentence paragraphs--
these should all be combined.
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No
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 the 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.
none
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Vertical distance from navel as a risk factor for bowel obstruction
associated with feeding jejunostomy after esophagectomy : a retrospective
cohort study
Version: 
1 
Date: 
16 Aug 2020
Reviewer's report:
The authors present a retrospective review of 70 patients who underwent
'thoracoscopic' esophagectomy between March 2013 and December 2019 of
whom 6 patients developed bowel obstruction after feeding jejunostomy tube
placement (BOFJ). They found that the vertical distance between the umbilicus
and the j-tube site was the only significant factor that predicted BOFJ. I have
several questions and concerns about this manuscript.
1.) I am worried that you have a significant variable that you do not seem to
have taken into account--this is the fact that you changed the type of abdominal
mobilization you were using after the first two years--going from hand-assisted
to a more complete laparoscopic approach for the final 4 years. In doing this, you
changed the location of your incision to one in the upper abdomen to one closer
to the umbilicus. It seems pretty clear to this reader that in doing so you have
naturally changed the location of where the j-tube would most naturally lie--
lower in the latter half of your experience. So, please tell us how many patients
were in each group (HALS vs. laparoscopic) and the BOFJ--did these all occur
in the patients undergoing HALS? This may be difficult to evaluate statistically
because there are so few patients with bowel obstruction. 
2.) I think you need to better define your terminology for esophagectomy. You
state it is a thoracoscopic esophagectomy but this is only part of the procedure
you describe in your methods. It is really what we would call a 3-hole
esophagectomy with an abdominal component and an anastomosis in the neck.
3.) You had 3 patients that had 3 or more episodes (I think) of BOFJ--one
wonders why these obstructions were not treated more aggressively with FJ
removal after one or two bouts.
4.) Why did your patients undergo neoadjuvant chemotherapy as opposed to
chemoradiation which is standard of care based on CROSS trial results.
5.) All of your patients appear to have had an abdominal CT scan performed
within one month after the primary operation by which you measured the
vertical distance--Is this CT scan part of your normal routine? Why a 30 day CT
scan--is it part of some sort of protocol?
Minor issues:
There is a sentence in the results section of the abstract that does not make
sense--"Conducting univariate analysis, logistic regression analysis showed...." Is
is logistic regression or univariate analysis?
Your paragraphs should be indented to signify a new paragraph
In your methods section on page 4, you have several one sentence paragraphs--
these should all be combined.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
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 the 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.
none
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Vertical distance from navel as a risk factor for bowel obstruction
associated with feeding jejunostomy after esophagectomy : a retrospective
cohort study
Version: 
1 
Date: 
16 Aug 2020
Reviewer's report:
The authors present a retrospective review of 70 patients who underwent
'thoracoscopic' esophagectomy between March 2013 and December 2019 of
whom 6 patients developed bowel obstruction after feeding jejunostomy tube
placement (BOFJ). They found that the vertical distance between the umbilicus
and the j-tube site was the only significant factor that predicted BOFJ. I have
several questions and concerns about this manuscript.
1.) I am worried that you have a significant variable that you do not seem to
have taken into account--this is the fact that you changed the type of abdominal
mobilization you were using after the first two years--going from hand-assisted
to a more complete laparoscopic approach for the final 4 years. In doing this, you
changed the location of your incision to one in the upper abdomen to one closer
to the umbilicus. It seems pretty clear to this reader that in doing so you have
naturally changed the location of where the j-tube would most naturally lie--
lower in the latter half of your experience. So, please tell us how many patients
were in each group (HALS vs. laparoscopic) and the BOFJ--did these all occur
in the patients undergoing HALS? This may be difficult to evaluate statistically
because there are so few patients with bowel obstruction. 
2.) I think you need to better define your terminology for esophagectomy. You
state it is a thoracoscopic esophagectomy but this is only part of the procedure
you describe in your methods. It is really what we would call a 3-hole
esophagectomy with an abdominal component and an anastomosis in the neck.
3.) You had 3 patients that had 3 or more episodes (I think) of BOFJ--one
wonders why these obstructions were not treated more aggressively with FJ
removal after one or two bouts.
4.) Why did your patients undergo neoadjuvant chemotherapy as opposed to
chemoradiation which is standard of care based on CROSS trial results.
5.) All of your patients appear to have had an abdominal CT scan performed
within one month after the primary operation by which you measured the
vertical distance--Is this CT scan part of your normal routine? Why a 30 day CT
scan--is it part of some sort of protocol?
Minor issues:
There is a sentence in the results section of the abstract that does not make
sense--"Conducting univariate analysis, logistic regression analysis showed...." Is
is logistic regression or univariate analysis?
Your paragraphs should be indented to signify a new paragraph
In your methods section on page 4, you have several one sentence paragraphs--
these should all be combined.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
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 the 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.
none
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant