Reviewer’s report
Title:  Complete  excision  of  esophageal  bronchogenic  cyst  by  endoscopic  submucosal  tunnel  
dissection: A case Presentation
Version: 2 Date: 24 Jun 2019
Reviewer: Apostolos V. Tsolakis
Reviewer's report:
This is a case report by Dr. Xun Yang et al. entitled "Complete excision of esophageal bronchogenic  
cyst by endoscopic submucosal tunnel dissection: A case report".
The  authors  present  their  experience  by  using  ESTD  for  endoscopically  treating  a  patient  with  
intramural  esophageal  bronchogenic  cyst.  The  authors  postulate  that  it  is  the  first  case  reported  
achieving radical excision using ESTD for treating such cyst.
According  to  the  authors  a  previously reported  case  treated  with  ESTD  by Tang  Xiaowei  et  al.  
Endoscopy 2014; 46: E626-E627 was not radically excised.
Major points:
As the patient was asymptomatic and there was no definite diagnosis of the lesion why did the authors  
proceeded to ESTD as the cyst could be of another more benign nature? ESTD is an interventional  
approach that harbors possible complications compared to follow up that is more benign. How the  
authors address this question?
Minor points:
I suggest that the authors should mention and comment on the fact that the differential diagnosis  
between esophageal bronchogenic versus duplication cyst can be challenging before having access to  
the pathology report.
EUS FNA can be an alternative in adding at the diagnosis of the cystic lesion but it includes risk of  
infection etc. On the other hand, duplication cysts can only be followed up if they are asymptomatic.  
Could the authors comment why they have not performed EUS FNA and analysis of the cystic fluid  
before performing ESTD?
Fig 2. It would be more representative to include EUS with doppler to show that there is no flow and  
the lesion represents a cyst. To my opinion the lesion is anechoic and not hypoechoic as the authors  
refer to and I suggest that the proper word will be used.
Fig 4. B. The Fig referred to the dissociation of the cyst is not representative. Can the authors replace it  
with a better one?
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.
Yes
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  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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.
No conflict.
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 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:  Complete  excision  of  esophageal  bronchogenic  cyst  by  endoscopic  submucosal  tunnel  
dissection: A case Presentation
Version: 2 Date: 24 Jun 2019
Reviewer: Apostolos V. Tsolakis
Reviewer's report:
This is a case report by Dr. Xun Yang et al. entitled "Complete excision of esophageal bronchogenic  
cyst by endoscopic submucosal tunnel dissection: A case report".
The  authors  present  their  experience  by  using  ESTD  for  endoscopically  treating  a  patient  with  
intramural  esophageal  bronchogenic  cyst.  The  authors  postulate  that  it  is  the  first  case  reported  
achieving radical excision using ESTD for treating such cyst.
According  to  the  authors  a  previously reported  case  treated  with  ESTD  by Tang  Xiaowei  et  al.  
Endoscopy 2014; 46: E626-E627 was not radically excised.
Major points:
As the patient was asymptomatic and there was no definite diagnosis of the lesion why did the authors  
proceeded to ESTD as the cyst could be of another more benign nature? ESTD is an interventional  
approach that harbors possible complications compared to follow up that is more benign. How the  
authors address this question?
Minor points:
I suggest that the authors should mention and comment on the fact that the differential diagnosis  
between esophageal bronchogenic versus duplication cyst can be challenging before having access to  
the pathology report.
EUS FNA can be an alternative in adding at the diagnosis of the cystic lesion but it includes risk of  
infection etc. On the other hand, duplication cysts can only be followed up if they are asymptomatic.  
Could the authors comment why they have not performed EUS FNA and analysis of the cystic fluid  
before performing ESTD?
Fig 2. It would be more representative to include EUS with doppler to show that there is no flow and  
the lesion represents a cyst. To my opinion the lesion is anechoic and not hypoechoic as the authors  
refer to and I suggest that the proper word will be used.
Fig 4. B. The Fig referred to the dissociation of the cyst is not representative. Can the authors replace it  
with a better one?
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.
Yes
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  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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.
No conflict.
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 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:  Complete  excision  of  esophageal  bronchogenic  cyst  by  endoscopic  submucosal  tunnel  
dissection: A case Presentation
Version: 2 Date: 24 Jun 2019
Reviewer: Apostolos V. Tsolakis
Reviewer's report:
This is a case report by Dr. Xun Yang et al. entitled "Complete excision of esophageal bronchogenic  
cyst by endoscopic submucosal tunnel dissection: A case report".
The  authors  present  their  experience  by  using  ESTD  for  endoscopically  treating  a  patient  with  
intramural  esophageal  bronchogenic  cyst.  The  authors  postulate  that  it  is  the  first  case  reported  
achieving radical excision using ESTD for treating such cyst.
According  to  the  authors  a  previously reported  case  treated  with  ESTD  by Tang  Xiaowei  et  al.  
Endoscopy 2014; 46: E626-E627 was not radically excised.
Major points:
As the patient was asymptomatic and there was no definite diagnosis of the lesion why did the authors  
proceeded to ESTD as the cyst could be of another more benign nature? ESTD is an interventional  
approach that harbors possible complications compared to follow up that is more benign. How the  
authors address this question?
Minor points:
I suggest that the authors should mention and comment on the fact that the differential diagnosis  
between esophageal bronchogenic versus duplication cyst can be challenging before having access to  
the pathology report.
EUS FNA can be an alternative in adding at the diagnosis of the cystic lesion but it includes risk of  
infection etc. On the other hand, duplication cysts can only be followed up if they are asymptomatic.  
Could the authors comment why they have not performed EUS FNA and analysis of the cystic fluid  
before performing ESTD?
Fig 2. It would be more representative to include EUS with doppler to show that there is no flow and  
the lesion represents a cyst. To my opinion the lesion is anechoic and not hypoechoic as the authors  
refer to and I suggest that the proper word will be used.
Fig 4. B. The Fig referred to the dissociation of the cyst is not representative. Can the authors replace it  
with a better one?
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.
Yes
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  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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.
No conflict.
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 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