Reviewer’s report
Title: 
Endoscopic Ultrasound with Fine Needle Aspiration is useful in
pancreatic cysts smaller than 3 cm
Version: 
0 
Date: 
05 Jul 2020
Reviewer's report:
The authors looked at pancreatic cysts <3 cm that are usually considered low-risk
by current guidelines. Based on their results, they maintain that there is no
significant difference between cysts smaller and greater than 3 cm, and that cyst
size alone should not be taken as a determinant to establish malignant potential. 
Overall, the study appears well conducted and documented. The methods are
clear and the discussion is balanced. I have a few remarks
1) Case selection is what bothers me most. The authors enrolled 115/167 patients
presenting with pancreatic cysts <3 cm. The reasons for excluding 52 patients
should be elucidated as these represented a significant amount of the whole
population.
2) Please explain the reasons for employing a 25-Gauge needle, which is not the
preferred choice when cystic fluid has to be aspirated. Maybe solid components
were the main target in these cases?
3) Please explain the reasons for prolonging ciprofloxacin for five days after the
procedure especially in light of recent literature evidence showing that antibiotic
prophylaxis might not be needed at all before EUS-FNA of pancreatic cysts.
4) I believe that the striking difference in malignancy rates between symptomatic
and non-symptomatic patients is not adequately emphasized in the discussion. In
these difficult-to-manage conditions, it is very important that we behave as fully
developed clinicians and not restrict ourselves just to EUS features evaluation.
5) Page 7, line 143: please amend "septa"
6) Page 10, line 233: amend "mass"
7) Page 10, line 237-238: please use past tense if you are referring to your own
results. On the contrary, this sentence should be moved to the discussion.
8) Please discuss briefly the role of CH-EUS in this context.
9) Literature to be cited:
Colán-Hernández J, Sendino O, Loras C, et al. Antibiotic Prophylaxis Is Not
Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of
Pancreatic Cystic Lesions, Based on a Randomized Trial. Gastroenterology
2020;158:1642-1649.
Fusaroli, P., Serrani, M., De Giorgio, R., D'Ercole, M.C., Ceroni, L., Lisotti, A.,
Caletti, G. Contrast Harmonic-Endoscopic Ultrasound Is Useful to Identify
Neoplastic Features of Pancreatic Cysts (With Videos) Pancreas 2016;45:265-
268. 
Fusaroli, P., Kypraios, D., Eloubeidi, M.A., Caletti, G. Levels of evidence in
endoscopic ultrasonography: A systematic review Digestive Diseases and
Sciences 2012;57:602-609. 
Publons Reviewer Recognition
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Yes
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
No competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Reviewer’s report
Title: 
Endoscopic Ultrasound with Fine Needle Aspiration is useful in
pancreatic cysts smaller than 3 cm
Version: 
0 
Date: 
05 Jul 2020
Reviewer's report:
The authors looked at pancreatic cysts <3 cm that are usually considered low-risk
by current guidelines. Based on their results, they maintain that there is no
significant difference between cysts smaller and greater than 3 cm, and that cyst
size alone should not be taken as a determinant to establish malignant potential. 
Overall, the study appears well conducted and documented. The methods are
clear and the discussion is balanced. I have a few remarks
1) Case selection is what bothers me most. The authors enrolled 115/167 patients
presenting with pancreatic cysts <3 cm. The reasons for excluding 52 patients
should be elucidated as these represented a significant amount of the whole
population.
2) Please explain the reasons for employing a 25-Gauge needle, which is not the
preferred choice when cystic fluid has to be aspirated. Maybe solid components
were the main target in these cases?
3) Please explain the reasons for prolonging ciprofloxacin for five days after the
procedure especially in light of recent literature evidence showing that antibiotic
prophylaxis might not be needed at all before EUS-FNA of pancreatic cysts.
4) I believe that the striking difference in malignancy rates between symptomatic
and non-symptomatic patients is not adequately emphasized in the discussion. In
these difficult-to-manage conditions, it is very important that we behave as fully
developed clinicians and not restrict ourselves just to EUS features evaluation.
5) Page 7, line 143: please amend "septa"
6) Page 10, line 233: amend "mass"
7) Page 10, line 237-238: please use past tense if you are referring to your own
results. On the contrary, this sentence should be moved to the discussion.
8) Please discuss briefly the role of CH-EUS in this context.
9) Literature to be cited:
Colán-Hernández J, Sendino O, Loras C, et al. Antibiotic Prophylaxis Is Not
Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of
Pancreatic Cystic Lesions, Based on a Randomized Trial. Gastroenterology
2020;158:1642-1649.
Fusaroli, P., Serrani, M., De Giorgio, R., D'Ercole, M.C., Ceroni, L., Lisotti, A.,
Caletti, G. Contrast Harmonic-Endoscopic Ultrasound Is Useful to Identify
Neoplastic Features of Pancreatic Cysts (With Videos) Pancreas 2016;45:265-
268. 
Fusaroli, P., Kypraios, D., Eloubeidi, M.A., Caletti, G. Levels of evidence in
endoscopic ultrasonography: A systematic review Digestive Diseases and
Sciences 2012;57:602-609. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
No competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Please review this paper.
user
Reviewer’s report
Title: 
Endoscopic Ultrasound with Fine Needle Aspiration is useful in
pancreatic cysts smaller than 3 cm
Version: 
0 
Date: 
05 Jul 2020
Reviewer's report:
The authors looked at pancreatic cysts <3 cm that are usually considered low-risk
by current guidelines. Based on their results, they maintain that there is no
significant difference between cysts smaller and greater than 3 cm, and that cyst
size alone should not be taken as a determinant to establish malignant potential. 
Overall, the study appears well conducted and documented. The methods are
clear and the discussion is balanced. I have a few remarks
1) Case selection is what bothers me most. The authors enrolled 115/167 patients
presenting with pancreatic cysts <3 cm. The reasons for excluding 52 patients
should be elucidated as these represented a significant amount of the whole
population.
2) Please explain the reasons for employing a 25-Gauge needle, which is not the
preferred choice when cystic fluid has to be aspirated. Maybe solid components
were the main target in these cases?
3) Please explain the reasons for prolonging ciprofloxacin for five days after the
procedure especially in light of recent literature evidence showing that antibiotic
prophylaxis might not be needed at all before EUS-FNA of pancreatic cysts.
4) I believe that the striking difference in malignancy rates between symptomatic
and non-symptomatic patients is not adequately emphasized in the discussion. In
these difficult-to-manage conditions, it is very important that we behave as fully
developed clinicians and not restrict ourselves just to EUS features evaluation.
5) Page 7, line 143: please amend "septa"
6) Page 10, line 233: amend "mass"
7) Page 10, line 237-238: please use past tense if you are referring to your own
results. On the contrary, this sentence should be moved to the discussion.
8) Please discuss briefly the role of CH-EUS in this context.
9) Literature to be cited:
Colán-Hernández J, Sendino O, Loras C, et al. Antibiotic Prophylaxis Is Not
Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of
Pancreatic Cystic Lesions, Based on a Randomized Trial. Gastroenterology
2020;158:1642-1649.
Fusaroli, P., Serrani, M., De Giorgio, R., D'Ercole, M.C., Ceroni, L., Lisotti, A.,
Caletti, G. Contrast Harmonic-Endoscopic Ultrasound Is Useful to Identify
Neoplastic Features of Pancreatic Cysts (With Videos) Pancreas 2016;45:265-
268. 
Fusaroli, P., Kypraios, D., Eloubeidi, M.A., Caletti, G. Levels of evidence in
endoscopic ultrasonography: A systematic review Digestive Diseases and
Sciences 2012;57:602-609. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
No competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
assistant