Reviewer's report 
 Recurrent Barrett's Esophagus and Adenocarcinoma After Esophagectomy Title: 
 1  30 May 2004 Version: Date: 
 Luigi Bonavina Reviewer: 
Reviewer's report: 
This article is in line with other published reports showing the appearance 
or the persistance of intestinal metaplasia in the esophageal remnant after esophagectomy and 
gastric pullup. Indeed,a thoughtful surgeon should always resect all metaplastic epithelium in these patients to avoid metachronous cancer. On the other hand, the only possibility to prevent recurrent 
Barrett is to replace the entire esophagus with colon, but this is a more complex and long operation. I 
find very clear the first message given by the authors: regular endoscopic surveillance is mandatory 
in these patients after esophagectomy. The second message, as emerged in the discussion and conclusions, is not as clear since no objective pH data are provided: should we really treat these patients for ever with such high-dose PPI regimen(160 mg esomeprazole!) irrespective of symptoms 
and histological features? 
------------------------------------------------------------------------------- ----------------------------------------------------------------------------- Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
The authors should indicate: a)whether the esophagectomy had been performed transthoracically or 
transhiatally, and the site of the anastomosis (chest vs neck); 
b) the prevalence and type of postsurgical symptoms in their patient 
population------------------------------------------------------------------------------- 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
none 
Reviewer's report 
 Recurrent Barrett's Esophagus and Adenocarcinoma After Esophagectomy Title: 
 1  30 May 2004 Version: Date: 
 Luigi Bonavina Reviewer: 
Reviewer's report: 
This article is in line with other published reports showing the appearance 
or the persistance of intestinal metaplasia in the esophageal remnant after esophagectomy and 
gastric pullup. Indeed,a thoughtful surgeon should always resect all metaplastic epithelium in these patients to avoid metachronous cancer. On the other hand, the only possibility to prevent recurrent 
Barrett is to replace the entire esophagus with colon, but this is a more complex and long operation. I 
find very clear the first message given by the authors: regular endoscopic surveillance is mandatory 
in these patients after esophagectomy. The second message, as emerged in the discussion and conclusions, is not as clear since no objective pH data are provided: should we really treat these patients for ever with such high-dose PPI regimen(160 mg esomeprazole!) irrespective of symptoms 
and histological features? 
------------------------------------------------------------------------------- ----------------------------------------------------------------------------- Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
The authors should indicate: a)whether the esophagectomy had been performed transthoracically or 
transhiatally, and the site of the anastomosis (chest vs neck); 
b) the prevalence and type of postsurgical symptoms in their patient 
population------------------------------------------------------------------------------- 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
none 
Please review this paper.
user
Reviewer's report 
 Recurrent Barrett's Esophagus and Adenocarcinoma After Esophagectomy Title: 
 1  30 May 2004 Version: Date: 
 Luigi Bonavina Reviewer: 
Reviewer's report: 
This article is in line with other published reports showing the appearance 
or the persistance of intestinal metaplasia in the esophageal remnant after esophagectomy and 
gastric pullup. Indeed,a thoughtful surgeon should always resect all metaplastic epithelium in these patients to avoid metachronous cancer. On the other hand, the only possibility to prevent recurrent 
Barrett is to replace the entire esophagus with colon, but this is a more complex and long operation. I 
find very clear the first message given by the authors: regular endoscopic surveillance is mandatory 
in these patients after esophagectomy. The second message, as emerged in the discussion and conclusions, is not as clear since no objective pH data are provided: should we really treat these patients for ever with such high-dose PPI regimen(160 mg esomeprazole!) irrespective of symptoms 
and histological features? 
------------------------------------------------------------------------------- ----------------------------------------------------------------------------- Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
The authors should indicate: a)whether the esophagectomy had been performed transthoracically or 
transhiatally, and the site of the anastomosis (chest vs neck); 
b) the prevalence and type of postsurgical symptoms in their patient 
population------------------------------------------------------------------------------- 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
none 
assistant