Review for 10.1186/s12876-020-01480-z (2020)

Reviewer’ s report
Title: Three-tube method and covered metallic stent for the treatment of anastomotic leakage after
esophagectomy
Version: 0Date: 04 Aug 2020
Reviewer's report:
This study retrospectively reviews the outcome of a particular method to address anastomotic
insufficiency after esophagectomy in 26 patients; using covered stents, internal drainage of abscesscavities, nasojejunal feeding and gastric decompression tubes.
The authors have to be congratulated for a paper addressing a topic of timely relevance. However,
I have some questions and remarks:
The paper will profit from a correction by a native English speaker, eg p5 line 9: remains
challenging
The observation period seems quite long: 7 years, were there no changes in technique? Were there
other patients treated differently?How were the esophagectomies performed or rather where were the anastomoses located? Theexclusion criteria make no senseWere there no patients treated under general anesthesia?Continuous negative pressure: how much; rinsed with how much saline per day?
What do you do when the esophageal stent does not fit watertight despite a good positioning?
Did you observe necrosis due to the drainage pressed to the wall?
Demographic data of patients need more attention, BMI, comorbidities,…
Were there any patients in need of (external) thoracic drainage?
I have a hard time understanding the course of the 16 successfully treated patients: why were the
stents not removed in the other 2?The follow-up should be reported differently: after fixed time-marks such as 1 month,…
P10, line 8: actually, nowadays, treatment of choice in the first line is an endoscopic approachPlease report the interval between surgery and leakage in days not months
Did you use stent fixation devices?
I think there are some more limitations: long interval and others stated aboveEsophageal strick: please change to a more common term
All in all: I think you included two different kind of patients: esophageal insufficiency and fistulae,
more than 5 months after the initial surgery and around a week
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(default)
Is the study design appropriate to answer the research question (including the use of appropriate
controls), and are the conclusions supported by the evidence presented?
YesAre the methods sufficiently described to allow the study to be repeated?NoIs the use of statistics and treatment of uncertainties appropriate?YesIs the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes