Reviewer's report
Title:Plastic or metal stents for benign biliary strictures: a systematic review
Version: 1Date:23 August 2009
Reviewer: Martin Freeman
Reviewer's report:
This is very well executed and timely review of the literature on endoscopic
therapy of benign biliary strictures. The main limitation is lack of separation of
types of strictures. The authors are no doubt aware of the Bismuth Class of
benign post-operative injuries, I-V, with hilar strictures much more difficult to treat
than mid or distal bile duct strictures. This is especially true for post liver
transplant strictures, where there are at least three distinct types: anastamotic (in
deceased donor transplants) anastamotic for living donor (usually much more
complex and smaller ducts, sometimes multiple anastamoses). THen there are
nonanastamotic (ischemic) injuries that tend to be hilar, and very difficult to treat.
Might the outcomes reported have as much to do with type of stricture treated as
to technique? Probably cannot be determined from studies reported, but this
should be emphasized in discussion. Also, there may be selection bias in the
series of cSEMS, as they may have been chosen in more "refractory" cases.
Would simply add these issues to discussion.
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Plastic or metal stents for benign biliary strictures: a systematic review
Version: 1Date:23 August 2009
Reviewer: Martin Freeman
Reviewer's report:
This is very well executed and timely review of the literature on endoscopic
therapy of benign biliary strictures. The main limitation is lack of separation of
types of strictures. The authors are no doubt aware of the Bismuth Class of
benign post-operative injuries, I-V, with hilar strictures much more difficult to treat
than mid or distal bile duct strictures. This is especially true for post liver
transplant strictures, where there are at least three distinct types: anastamotic (in
deceased donor transplants) anastamotic for living donor (usually much more
complex and smaller ducts, sometimes multiple anastamoses). THen there are
nonanastamotic (ischemic) injuries that tend to be hilar, and very difficult to treat.
Might the outcomes reported have as much to do with type of stricture treated as
to technique? Probably cannot be determined from studies reported, but this
should be emphasized in discussion. Also, there may be selection bias in the
series of cSEMS, as they may have been chosen in more "refractory" cases.
Would simply add these issues to discussion.
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Plastic or metal stents for benign biliary strictures: a systematic review
Version: 1Date:23 August 2009
Reviewer: Martin Freeman
Reviewer's report:
This is very well executed and timely review of the literature on endoscopic
therapy of benign biliary strictures. The main limitation is lack of separation of
types of strictures. The authors are no doubt aware of the Bismuth Class of
benign post-operative injuries, I-V, with hilar strictures much more difficult to treat
than mid or distal bile duct strictures. This is especially true for post liver
transplant strictures, where there are at least three distinct types: anastamotic (in
deceased donor transplants) anastamotic for living donor (usually much more
complex and smaller ducts, sometimes multiple anastamoses). THen there are
nonanastamotic (ischemic) injuries that tend to be hilar, and very difficult to treat.
Might the outcomes reported have as much to do with type of stricture treated as
to technique? Probably cannot be determined from studies reported, but this
should be emphasized in discussion. Also, there may be selection bias in the
series of cSEMS, as they may have been chosen in more "refractory" cases.
Would simply add these issues to discussion.
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'
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