Reviewer ’s report  
 
Title: Efficacy and safety of c hemotherapy after endoscopic double stenting for malignant 
duodenal and biliary obstructions in patients with advanced pancreatic cancer: a single -
institution retrospective analysis.  
 
Version: 0 Date: 12 Feb 2018  
 
Reviewer: Aaron R. Sasson  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than upload ing your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comme nts to the authors.  
This is a well written manuscript regarding palliation of advanced pancreas cancer. The authors 
described their experience of 50 patient's requiring endoscopic palliation of biliary and duodenal 
obstruction. I have several questions an d comments.  
The author's note a 24% biliary stent re -intervention rate. They also note the use of plastic stents 
in approximately a quarter of the patient's. This could account for their need for biliary stent 
intervention. If the authors could comment on  the utilization of plastic stents and correlated with 
failure rate.  
Management of biliary obstruction in combination with type II duodenal obstruction can be quite 
challenging. They should elaborate in their methods of how they managed that particular cli nical 
situation.  
The authors need to highlight the significant improvement in the gastric outlet obstruction 
severity score. This is currently mentioned in the results section however since palliation is the 
primary goal in these patients, this should be emphasized  
The authors do a significant amount of analysis regarding the prognostic information of duodenal 
stent as it relates to survival, however this is somewhat unnecessary as the patients have 
advanced pancreas cancer many of whom have failed first -line therapy or receiving best 
supportive care.  
On a minor note they have a spelling mistake. On page 13, the word "fetal" is utilized when the 
proper word is "fatal"  
 
  
Are the methods appropriate a nd 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.  
 
Yes 
 
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 reco mmended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing inter ests 
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 y es to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publica tion, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Efficacy and safety of c hemotherapy after endoscopic double stenting for malignant 
duodenal and biliary obstructions in patients with advanced pancreatic cancer: a single -
institution retrospective analysis.  
 
Version: 0 Date: 12 Feb 2018  
 
Reviewer: Aaron R. Sasson  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than upload ing your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comme nts to the authors.  
This is a well written manuscript regarding palliation of advanced pancreas cancer. The authors 
described their experience of 50 patient's requiring endoscopic palliation of biliary and duodenal 
obstruction. I have several questions an d comments.  
The author's note a 24% biliary stent re -intervention rate. They also note the use of plastic stents 
in approximately a quarter of the patient's. This could account for their need for biliary stent 
intervention. If the authors could comment on  the utilization of plastic stents and correlated with 
failure rate.  
Management of biliary obstruction in combination with type II duodenal obstruction can be quite 
challenging. They should elaborate in their methods of how they managed that particular cli nical 
situation.  
The authors need to highlight the significant improvement in the gastric outlet obstruction 
severity score. This is currently mentioned in the results section however since palliation is the 
primary goal in these patients, this should be emphasized  
The authors do a significant amount of analysis regarding the prognostic information of duodenal 
stent as it relates to survival, however this is somewhat unnecessary as the patients have 
advanced pancreas cancer many of whom have failed first -line therapy or receiving best 
supportive care.  
On a minor note they have a spelling mistake. On page 13, the word "fetal" is utilized when the 
proper word is "fatal"  
 
  
Are the methods appropriate a nd 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.  
 
Yes 
 
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 reco mmended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing inter ests 
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 y es to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publica tion, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Efficacy and safety of c hemotherapy after endoscopic double stenting for malignant 
duodenal and biliary obstructions in patients with advanced pancreatic cancer: a single -
institution retrospective analysis.  
 
Version: 0 Date: 12 Feb 2018  
 
Reviewer: Aaron R. Sasson  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than upload ing your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comme nts to the authors.  
This is a well written manuscript regarding palliation of advanced pancreas cancer. The authors 
described their experience of 50 patient's requiring endoscopic palliation of biliary and duodenal 
obstruction. I have several questions an d comments.  
The author's note a 24% biliary stent re -intervention rate. They also note the use of plastic stents 
in approximately a quarter of the patient's. This could account for their need for biliary stent 
intervention. If the authors could comment on  the utilization of plastic stents and correlated with 
failure rate.  
Management of biliary obstruction in combination with type II duodenal obstruction can be quite 
challenging. They should elaborate in their methods of how they managed that particular cli nical 
situation.  
The authors need to highlight the significant improvement in the gastric outlet obstruction 
severity score. This is currently mentioned in the results section however since palliation is the 
primary goal in these patients, this should be emphasized  
The authors do a significant amount of analysis regarding the prognostic information of duodenal 
stent as it relates to survival, however this is somewhat unnecessary as the patients have 
advanced pancreas cancer many of whom have failed first -line therapy or receiving best 
supportive care.  
On a minor note they have a spelling mistake. On page 13, the word "fetal" is utilized when the 
proper word is "fatal"  
 
  
Are the methods appropriate a nd 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.  
 
Yes 
 
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 reco mmended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing inter ests 
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 y es to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publica tion, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant