Title: Stenting of the pancreatic duct in the early phase of acute pancreatitis: a retrospective
study
Version: 0 Date: 03 Jul 2022
Reviewer's report:
The authors carry out a retrospective cohort study in 131 patients in which they determine
the efficacy and safety of early pancreatic duct setting for acute pancreatitis. The authors
demonstrate that pancreatic duct stunting has the potencial to reduce pain relief time, oral
refeeding time and hospital stay time.
Congratulations to the authors for having been able to carry out this study about very
controversial subject.
It has various  issues and some points of clarity from the authors would be helpful.
The first questions are philosophical in nature: how do the authors explain the differences they
have found between the two groups of patients analyzed in the study? One of the reasons given
in the introductions that “PD stent placement can reduce ongoing pancreatic injury by providing
adequate drainage of pancreatic fluids”.
1. If the IAP/APA and AGA guidelines consider that ERCP is not indicated due to the high
risk of complications in patients with AP and worse prognosis for these patients . It is only
recommended in patients with cholangitis (GRADE 1A). In this context, it is difficult to
understand the indication for an ERCP.
2. The authors describe few complications in performing ERCP thanks to their expertise, but
without ERCP procedure, perhaps the evolution  that they find is the natural evolution of AP
in each of the cases.
3. They describe that the treatment used is described in the guidelines. Nonetheless, in recent
years, there is well-established evidence that in patients with mild AP, an early oral diet can be
started immediately with good results and prognosis.
Considering that more than 90% are mild AP, perhaps only optimized medical treatment and an
early diet are sufficient for the clinical improvement of the patient and the reduction of hospital
stays, admissions and stay in the ICU, severity and improvement of pain. Factors that the authors
consider to be improved by the stent (?).
4. The analysis of lipase and amylase is not clear to me,  it is known that both lipase and amylase
lack the capacity to determine the severity and etiology of acute pancreatitis. The joint ordering
of both tests has shown little or no increase in diagnostic sensitivity and specificity.
5. I do not understand how, based on a retrospective study, few patients and cases and controls
study can find risk factors  of severity. Factors in which the lipase and amylase are included.
Understanding the statistical analysis performed and perhaps it is adequate but the discussion
is a little deeper.
6. Placing a stent with such a high risk of complications may not be necessary in a high-risk
patient. Perhaps the optimization of preserved management alone will help these patients to do
well and reduce all the results described by the authors with the placement of a stent.
Title: Stenting of the pancreatic duct in the early phase of acute pancreatitis: a retrospective
study
Version: 0 Date: 03 Jul 2022
Reviewer's report:
The authors carry out a retrospective cohort study in 131 patients in which they determine
the efficacy and safety of early pancreatic duct setting for acute pancreatitis. The authors
demonstrate that pancreatic duct stunting has the potencial to reduce pain relief time, oral
refeeding time and hospital stay time.
Congratulations to the authors for having been able to carry out this study about very
controversial subject.
It has various  issues and some points of clarity from the authors would be helpful.
The first questions are philosophical in nature: how do the authors explain the differences they
have found between the two groups of patients analyzed in the study? One of the reasons given
in the introductions that “PD stent placement can reduce ongoing pancreatic injury by providing
adequate drainage of pancreatic fluids”.
1. If the IAP/APA and AGA guidelines consider that ERCP is not indicated due to the high
risk of complications in patients with AP and worse prognosis for these patients . It is only
recommended in patients with cholangitis (GRADE 1A). In this context, it is difficult to
understand the indication for an ERCP.
2. The authors describe few complications in performing ERCP thanks to their expertise, but
without ERCP procedure, perhaps the evolution  that they find is the natural evolution of AP
in each of the cases.
3. They describe that the treatment used is described in the guidelines. Nonetheless, in recent
years, there is well-established evidence that in patients with mild AP, an early oral diet can be
started immediately with good results and prognosis.
Considering that more than 90% are mild AP, perhaps only optimized medical treatment and an
early diet are sufficient for the clinical improvement of the patient and the reduction of hospital
stays, admissions and stay in the ICU, severity and improvement of pain. Factors that the authors
consider to be improved by the stent (?).
4. The analysis of lipase and amylase is not clear to me,  it is known that both lipase and amylase
lack the capacity to determine the severity and etiology of acute pancreatitis. The joint ordering
of both tests has shown little or no increase in diagnostic sensitivity and specificity.
5. I do not understand how, based on a retrospective study, few patients and cases and controls
study can find risk factors  of severity. Factors in which the lipase and amylase are included.
Understanding the statistical analysis performed and perhaps it is adequate but the discussion
is a little deeper.
6. Placing a stent with such a high risk of complications may not be necessary in a high-risk
patient. Perhaps the optimization of preserved management alone will help these patients to do
well and reduce all the results described by the authors with the placement of a stent.
Please review this paper.
user
Title: Stenting of the pancreatic duct in the early phase of acute pancreatitis: a retrospective
study
Version: 0 Date: 03 Jul 2022
Reviewer's report:
The authors carry out a retrospective cohort study in 131 patients in which they determine
the efficacy and safety of early pancreatic duct setting for acute pancreatitis. The authors
demonstrate that pancreatic duct stunting has the potencial to reduce pain relief time, oral
refeeding time and hospital stay time.
Congratulations to the authors for having been able to carry out this study about very
controversial subject.
It has various  issues and some points of clarity from the authors would be helpful.
The first questions are philosophical in nature: how do the authors explain the differences they
have found between the two groups of patients analyzed in the study? One of the reasons given
in the introductions that “PD stent placement can reduce ongoing pancreatic injury by providing
adequate drainage of pancreatic fluids”.
1. If the IAP/APA and AGA guidelines consider that ERCP is not indicated due to the high
risk of complications in patients with AP and worse prognosis for these patients . It is only
recommended in patients with cholangitis (GRADE 1A). In this context, it is difficult to
understand the indication for an ERCP.
2. The authors describe few complications in performing ERCP thanks to their expertise, but
without ERCP procedure, perhaps the evolution  that they find is the natural evolution of AP
in each of the cases.
3. They describe that the treatment used is described in the guidelines. Nonetheless, in recent
years, there is well-established evidence that in patients with mild AP, an early oral diet can be
started immediately with good results and prognosis.
Considering that more than 90% are mild AP, perhaps only optimized medical treatment and an
early diet are sufficient for the clinical improvement of the patient and the reduction of hospital
stays, admissions and stay in the ICU, severity and improvement of pain. Factors that the authors
consider to be improved by the stent (?).
4. The analysis of lipase and amylase is not clear to me,  it is known that both lipase and amylase
lack the capacity to determine the severity and etiology of acute pancreatitis. The joint ordering
of both tests has shown little or no increase in diagnostic sensitivity and specificity.
5. I do not understand how, based on a retrospective study, few patients and cases and controls
study can find risk factors  of severity. Factors in which the lipase and amylase are included.
Understanding the statistical analysis performed and perhaps it is adequate but the discussion
is a little deeper.
6. Placing a stent with such a high risk of complications may not be necessary in a high-risk
patient. Perhaps the optimization of preserved management alone will help these patients to do
well and reduce all the results described by the authors with the placement of a stent.
assistant