Reviewer's report
Title:Caustic ingestion in adults: the role of endoscopic classification in
predicting outcome
Version: 1Date:22 January 2008
Reviewer: Jan-Werner W Poley
Reviewer's report:
General:
interesting series, one of the largest published, on caustic ingestions of interest
to anyone dealing with these kind of patients.
Major Revisions:
Introduction:
* please provide references with regards to both the protective effect of "eschar
formation" and the presumed pyloric spasm as a reaction to large amounts of
caustic substances
Methods:
* Please explain why this period was chosen
* please state whether the used 6 pt scale was used prospectively or
retrospectively based on reports and images/footage from the endoscopies
* Was nasogastric, nasojejunal or parenteral feeding used in these patients
Results
* Please explain or hypothesize why there was an age difference in distribution of
mucosal injury and, if this was used to adjust the data, how this affected
outcome.
* Please provide information on differences between the acid and alkali group
with regards to outcome on the chosen parameters.
* The subject of surgery is briefly touched upon. Please provide more information
on patients that went for surgery and their outcome.
* 66 patients had a stricture. 21 patients were dilated endoscopically (how and
how often and were any complications seen). 24 patients had a
gastrojejunostomy. Was this because of a gastric outlet or duodenal obstruction
and what was the timing of surgery (mortality 3/24!). How were the remaining
patients treated?
Discussion
* compared to some other series, especially those with a high percentage of
acidic intoxications, there is a marked difference with regards to severity of
mucosal damage (quite severe) and mortality (relatively low). Please comment
on this.
* the only significant difference between IIa and IIb was hospital stay. Do the
authors consider differentiating between IIa and IIb useful and reliable?
* especially since the difference betweeen IIIa and IIIb seems to be very
important clinically.
* please explain why patients with IIIb burns should be considered surgical
candidates. What was the outcome in patients that went for surgery and patients
that didn't? What were the characteristics of these patients?
I think one should be very careful to make these kind of recommendations based
on retrospective data.
Minor revisions:
Results:
* the amount of substance taken is sometimes very hard or impossible to
ascertain. Please mention this in the discussion (or results if available).
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Caustic ingestion in adults: the role of endoscopic classification in
predicting outcome
Version: 1Date:22 January 2008
Reviewer: Jan-Werner W Poley
Reviewer's report:
General:
interesting series, one of the largest published, on caustic ingestions of interest
to anyone dealing with these kind of patients.
Major Revisions:
Introduction:
* please provide references with regards to both the protective effect of "eschar
formation" and the presumed pyloric spasm as a reaction to large amounts of
caustic substances
Methods:
* Please explain why this period was chosen
* please state whether the used 6 pt scale was used prospectively or
retrospectively based on reports and images/footage from the endoscopies
* Was nasogastric, nasojejunal or parenteral feeding used in these patients
Results
* Please explain or hypothesize why there was an age difference in distribution of
mucosal injury and, if this was used to adjust the data, how this affected
outcome.
* Please provide information on differences between the acid and alkali group
with regards to outcome on the chosen parameters.
* The subject of surgery is briefly touched upon. Please provide more information
on patients that went for surgery and their outcome.
* 66 patients had a stricture. 21 patients were dilated endoscopically (how and
how often and were any complications seen). 24 patients had a
gastrojejunostomy. Was this because of a gastric outlet or duodenal obstruction
and what was the timing of surgery (mortality 3/24!). How were the remaining
patients treated?
Discussion
* compared to some other series, especially those with a high percentage of
acidic intoxications, there is a marked difference with regards to severity of
mucosal damage (quite severe) and mortality (relatively low). Please comment
on this.
* the only significant difference between IIa and IIb was hospital stay. Do the
authors consider differentiating between IIa and IIb useful and reliable?
* especially since the difference betweeen IIIa and IIIb seems to be very
important clinically.
* please explain why patients with IIIb burns should be considered surgical
candidates. What was the outcome in patients that went for surgery and patients
that didn't? What were the characteristics of these patients?
I think one should be very careful to make these kind of recommendations based
on retrospective data.
Minor revisions:
Results:
* the amount of substance taken is sometimes very hard or impossible to
ascertain. Please mention this in the discussion (or results if available).
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Caustic ingestion in adults: the role of endoscopic classification in
predicting outcome
Version: 1Date:22 January 2008
Reviewer: Jan-Werner W Poley
Reviewer's report:
General:
interesting series, one of the largest published, on caustic ingestions of interest
to anyone dealing with these kind of patients.
Major Revisions:
Introduction:
* please provide references with regards to both the protective effect of "eschar
formation" and the presumed pyloric spasm as a reaction to large amounts of
caustic substances
Methods:
* Please explain why this period was chosen
* please state whether the used 6 pt scale was used prospectively or
retrospectively based on reports and images/footage from the endoscopies
* Was nasogastric, nasojejunal or parenteral feeding used in these patients
Results
* Please explain or hypothesize why there was an age difference in distribution of
mucosal injury and, if this was used to adjust the data, how this affected
outcome.
* Please provide information on differences between the acid and alkali group
with regards to outcome on the chosen parameters.
* The subject of surgery is briefly touched upon. Please provide more information
on patients that went for surgery and their outcome.
* 66 patients had a stricture. 21 patients were dilated endoscopically (how and
how often and were any complications seen). 24 patients had a
gastrojejunostomy. Was this because of a gastric outlet or duodenal obstruction
and what was the timing of surgery (mortality 3/24!). How were the remaining
patients treated?
Discussion
* compared to some other series, especially those with a high percentage of
acidic intoxications, there is a marked difference with regards to severity of
mucosal damage (quite severe) and mortality (relatively low). Please comment
on this.
* the only significant difference between IIa and IIb was hospital stay. Do the
authors consider differentiating between IIa and IIb useful and reliable?
* especially since the difference betweeen IIIa and IIIb seems to be very
important clinically.
* please explain why patients with IIIb burns should be considered surgical
candidates. What was the outcome in patients that went for surgery and patients
that didn't? What were the characteristics of these patients?
I think one should be very careful to make these kind of recommendations based
on retrospective data.
Minor revisions:
Results:
* the amount of substance taken is sometimes very hard or impossible to
ascertain. Please mention this in the discussion (or results if available).
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
assistant