Review for 10.1186/s12876-021-01624-9 (2021)

Reviewer’s report
Title: 
Aorto-esophageal fistula caused by fishbone ingestion: a case report on
staged endovascular and endoscopic treatment
Version: 
0 
Date: 
10 Nov 2020
Reviewer's report:
In this case report entitled "Aorto-esophageal fistula caused by fishbone
ingestion: a case report on staged endovascular and endoscopic treatment", the
authors have reported a case of aorto-esophageal fistula (AEF) managed using
TEVAR and endoclips. 
AEF is among the rarest causes of upper GI bleeding with fatal outcomes if not
managed early. 
I have the following comments for the report:
1. Figure 1 A and B are similar, both revealing aortic stent graft. One of these
can be deleted.
2. It may be worthwhile to include a pre-TEVAR CT image (coronal and
sagittal) with details of the AEF.
3. Kindly include the size and make of the aortic stent graft. 
4. Although, successful endoscopic closure of esophageal fistulae has been
reported failure rate is high. The endoscopic images in the current report reveal
thickened edges of the fistula partially closed with clips (2b). It seems unlikely
that the endoclips placement resulted in the closure of the fistulous opening. Did
the authors consider placement of a fully covered metal stent? Did the authors
continue with nasojejunal feeds after endoclipping? Kindly include an
endoscopic image revealing complete closure of the fistulous opening. 
5. Kindly consider including reports where endoscopic closure of AEF was
unsuccessful or where other endoscopic modalities were utilized. The success
with endoscopic closure in the current report should not be interpreted as the
standard of care in such a scenario. The authors should soften the conclusion and
provide a statement of caution in the discussion. 
Minor comments
1. Kindly consider revising the following sentences : page 4, line 1 "5 months
ago, the patient was diagnosed as aorto-esophageal fistula due to massive
hematemesis and melena after a fishbone ingestion"; "1 month ago,
reexamination of upper endoscopy indicated the growth of the esophageal fistula
about 6mm in diameter." 
2. Kindly consider revising the entire manuscript for grammatical and syntax
errors. 
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