Review for 10.1186/s12876-024-03191-1 (2024)

Title: Perioperative outcomes of the surgical management of achalasia in two tertiary
Cameroonian hospitals: a cohort study
Version: 1 Date: 24 Nov 2023
Reviewer:  Radhika Chavan
Reviewer's report:
In this article, the authors have analyzed peri-operative outcomes in surgically treated achalasia.
Study is interesting as it has been done in resource constraint setting. I have few questions to
the authors
1) Manuscript needs a substantial language editing to understand it.
2) In abstract and method, author mentioned 10 years period 2001-2021. However, from
2001-2021 is 20 years period.
3) In abstract: kindly rewrite results: shorten it. Compare pre and post Eckardts score.
4) Manuscript:
a) In background: Please remove “also termed as megaesophagus” from first line. Refrain from
using IMO at other places. Instead of IMO, achalasia cardia (AC) can be used. Have author
included only Sigmoid esophagus? Please elaborate.
b) Kindly shorten the background. Make it precise and lucid.
c) Please mention in the background (introduction), on the preference for achalasia treatment in
Cameroon. Do they consider other options like peroral endoscopic myotomy, pneumatic balloon
dilatation, Botox injection etc. How do they decide on the management of achalasia?
d) Is Nissens fundoplication performed for Achalasia?
e) Before writing surgical management, it is suggested to write on how diagnosis of achalasia
was made and any past history of other treatment. Hellers Myotomy is always an elective
procedure. Therefore, first line “all patients were operated electively” can be modified.
f) Do you have record of total number of patients with achalasia presented to the hospital? Of
them, how many received other treatment? This will help in better understanding.
g) Epidemiological data: kindly rewrite. Interestingly there were 2 infants with achalasia. How
achalasia was diagnosed in them – with gastroscopy or barium swallow?
h) Preoperative data: kindly rewrite as per the standard scientific language. The mean adult
preoperative Eckardt Score was 9 ± 1.1 with extremes ranging from 7 to 11. Rewrite it as - 9
± 1.1 (range 7-11).
i) Can you define diagnostic delay? Was it “symptoms duration” rather than diagnostic delay?
j) Author mentioned that; “upper GI endoscopy was performed in 25 (86.2%) patients, of
whom seven (28%) patients had no endoscopic sign of achalasia”. How these 7 patients were
diagnosed?
k) In result, it is not clear that author has only included sigmoid esophagus?
l) Refrain from using shortform like NGT. When do you consider nasogastric tube placement?
There were 8 intramucosal perforation, however only 4 received nasogastric tube.
m) Only 6 patients had postoperative barium swallow. Is there any protocol on preop or post
op evaluation of achalasia patients? What about the rest of the cases? When did patient resume
diet? Is it immediately on day 1- or 2/3-days post-surgery?
5) Discussion: Rewrite it without bullet points. Make it short and precise.
6) In tables, mention the percentage in same column of numbers – like 16 (55.2%).
7) Table 6: modify it, compare pre and post HM Eckardts score rather than individual symptoms.