Reviewer ’s report  
 
Title: Pancreatic duct guidewire placement for biliary cannulation as a risk factor for stone residue 
after endoscopic transpapillary stone removal  
 
Version: 0 Date: 01 Jul 2020  
 
Reviewer's report:  
 
Please include all comments for the authors in this bo x rather than uploading 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 wh en adding your comments to the authors.  
 
One of the important for the evaluation of residual stones (except CT, MRCP) is the patient's clinic 
after ERCP. Sometimes we think that we have completely removed the stones, but after ERCP, 
Bilirubin values do not decrease as we want, clinical symptoms continue. This factor is important 
in the evaluation of residual stones.  
In addition, another important factor is the ERCP room equipment, the quality of the device and 
quality cholangiography.  
 
Are the patients whose stone could not be removed or whose stone removal was postponed to the 
second session were excluded from the study?  
Are patients with choledochal stents removed from the study?  
It is very controversial to say that the cases were included within 2 months, w hy? Because, in 
patients with gall bladder stones, besides residual stones, the stone from the gall bladder may have 
fallen into the biliary tract.  
 
A case other than 2 months was excluded: Patients with stones in the gallbladder after ERCP need 
to undergo cholecystectomy within 2 months (if delayed cholecystectomy).  
Patient selection should be reevaluated.  
Pancreatic duct guidewire placement method (P -GW) The method used for choledochal 
cannulation. However, after choledoch cannulated, GW wire can be remove d and ERCP can be 
continued. If necessary, at the end of the procedure, a stent is placed in the pancreatic duct again 
via GW.  
 
RESULT: Beginning should start traditionally: working year, demographic data etc.  
Incidence and patient characteristics with resi dual even duct Stones: Only residual stones were 
detected with CT / MRCP. Maybe the patient's clinic and (  decreasing ,  increasing) bilirubin 
values should also be taken into consideration.  
In multiple logistic regression analysis, performing P -GW was re tained as the  
Independent factor of residual stones (odds ratio [OR], 3.4; 95% CI, 1.1 -9.5; P = 0.02). I respect 
the work result is endless. But I have over 2000 ERCP experience and I personally find this result 
suspicious.  
 
For residual stone factors: Ston e size, processing time, number of stones, characteristics of the 
patient's choledocal anatomy, duodenal diverticulum, insufficient EST, hardness of the stone, and 
others.  
 
The conclusion should be discussed and reevaluated. It would not be correct to conne ct the reason 
of the residual stone to P -GW only. The conclusion should be rewritten. Statistical data should be 
reevaluated. All factors affecting residual stone should be determined, whether they are 
meaningful or not.  
I wish you and your work team succe ss. 
 
Publons Reviewer Recognition . Springer Nature can send verifica tion 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 
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No 
 
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.  
 
No 
 
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 manus cript or would you recommend an additional 
statistical review?  
If an additiona l statistical review is recommended, please speci fy 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 financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financi ally 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 organiz ation 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 th e above, write 'I declare that I have no competing interests' below.  
If your reply is yes to any, please give details below.  
 
One of the important for the evaluation of residual stones (except CT, MRCP) is the patient's clinic 
after ERCP. Sometimes we think that we have completely removed the stones, but after ERCP, 
Bilirubin values do not decrease as we want, clinical symptoms cont inue. This factor is important 
in the evaluation of residual stones.  
In addition, another important factor is the ERCP room equipment, the quality of the device and 
quality cholangiography.  
Are the patients whose stone could not be removed or whose stone r emoval was postponed to the 
second session were excluded from the study?  
Are patients with choledochal stents removed from the study?  
It is very controversial to say that the cases were included within 2 months, why? Because, in 
patients with gall bladder stones, besides residual stones, the stone from the gall bladder may have 
fallen into the biliary tract.  
A case other than 2 months was excluded: Patients with stones in the gallbladder after ERCP need 
to undergo cholecystectomy within 2 months (if delayed  cholecystectomy).  
Patient selection should be reevaluated.  
Pancreatic duct guidewire placement method (P -GW) The method used for choledochal 
cannulation. However, after choledoch cannulated, GW wire can be removed and ERCP can be 
continued. If necessary, at the end of the procedure, a stent is placed in the pancreatic duct again 
via GW.  
RESULT: Beginning should start traditionally: working year, demographic data etc.  
Incidence and patient characteristics with residual even duct Stones: Only residual stones  were 
detected with CT / MRCP. Maybe the patient's clinic and (  decreasing ,  increasing) bilirubin 
values should also be taken into consideration.  
In multiple logistic regression analysis, performing P -GW was retained as the  
Independent factor of residua l stones (odds ratio [OR], 3.4; 95% CI, 1.1 –9.5; P = 0.02). I respect 
the work result is endless. But I have over 2000 ERCP experience and I personally find this result 
suspicious.  
For residual stone factors: Stone size, processing time, number of stones, characteristics of the 
patient's choledocal anatomy, duodenal diverticulum, insufficient EST, hardness of the stone, and 
others.  
The conclusion should be discussed and reevaluated. It would not be correct to connect the reason 
of the residual stone to P -GW only. The conclusion should be rewritten. Statistical data should be 
reevaluated. All factors affecting residual stone should be determined, whether they are 
meaningful or not.  
I wish you and your work team success.  
 
Reviewer Publication Consent. I agree for my report to be made available under an Ope n 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 e ditor, which will not be 
published.  If you are not happy for us to publish this report, please contact the edi torial office 
before completing the review.  If you wish, you can include your name in your publish ed 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 li cense; please do not publish my name with my report.  
(default)  
Reviewer ’s report  
 
Title: Pancreatic duct guidewire placement for biliary cannulation as a risk factor for stone residue 
after endoscopic transpapillary stone removal  
 
Version: 0 Date: 01 Jul 2020  
 
Reviewer's report:  
 
Please include all comments for the authors in this bo x rather than uploading 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 wh en adding your comments to the authors.  
 
One of the important for the evaluation of residual stones (except CT, MRCP) is the patient's clinic 
after ERCP. Sometimes we think that we have completely removed the stones, but after ERCP, 
Bilirubin values do not decrease as we want, clinical symptoms continue. This factor is important 
in the evaluation of residual stones.  
In addition, another important factor is the ERCP room equipment, the quality of the device and 
quality cholangiography.  
 
Are the patients whose stone could not be removed or whose stone removal was postponed to the 
second session were excluded from the study?  
Are patients with choledochal stents removed from the study?  
It is very controversial to say that the cases were included within 2 months, w hy? Because, in 
patients with gall bladder stones, besides residual stones, the stone from the gall bladder may have 
fallen into the biliary tract.  
 
A case other than 2 months was excluded: Patients with stones in the gallbladder after ERCP need 
to undergo cholecystectomy within 2 months (if delayed cholecystectomy).  
Patient selection should be reevaluated.  
Pancreatic duct guidewire placement method (P -GW) The method used for choledochal 
cannulation. However, after choledoch cannulated, GW wire can be remove d and ERCP can be 
continued. If necessary, at the end of the procedure, a stent is placed in the pancreatic duct again 
via GW.  
 
RESULT: Beginning should start traditionally: working year, demographic data etc.  
Incidence and patient characteristics with resi dual even duct Stones: Only residual stones were 
detected with CT / MRCP. Maybe the patient's clinic and (  decreasing ,  increasing) bilirubin 
values should also be taken into consideration.  
In multiple logistic regression analysis, performing P -GW was re tained as the  
Independent factor of residual stones (odds ratio [OR], 3.4; 95% CI, 1.1 -9.5; P = 0.02). I respect 
the work result is endless. But I have over 2000 ERCP experience and I personally find this result 
suspicious.  
 
For residual stone factors: Ston e size, processing time, number of stones, characteristics of the 
patient's choledocal anatomy, duodenal diverticulum, insufficient EST, hardness of the stone, and 
others.  
 
The conclusion should be discussed and reevaluated. It would not be correct to conne ct the reason 
of the residual stone to P -GW only. The conclusion should be rewritten. Statistical data should be 
reevaluated. All factors affecting residual stone should be determined, whether they are 
meaningful or not.  
I wish you and your work team succe ss. 
 
Publons Reviewer Recognition . Springer Nature can send verifica tion 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 yo ur new 
profile page. Publons may use the Review Data to generate derivat ive metadata for the benefit of 
Publons and you as a reviewer, carefully considering the sensi tivity of such information. For 
example, Publons may verify your record as a reviewer by u pdatin g your profile published  on its 
webservice if you have registered for such service or help editors t o identify candidate reviewers. 
Please find the details of processing in Publons ’ privacy policy https://publons.com/about/terms  
 
No 
 
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.  
 
No 
 
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 manus cript or would you recommend an additional 
statistical review?  
If an additiona l statistical review is recommended, please speci fy 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 financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financi ally 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 organiz ation 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 th e above, write 'I declare that I have no competing interests' below.  
If your reply is yes to any, please give details below.  
 
One of the important for the evaluation of residual stones (except CT, MRCP) is the patient's clinic 
after ERCP. Sometimes we think that we have completely removed the stones, but after ERCP, 
Bilirubin values do not decrease as we want, clinical symptoms cont inue. This factor is important 
in the evaluation of residual stones.  
In addition, another important factor is the ERCP room equipment, the quality of the device and 
quality cholangiography.  
Are the patients whose stone could not be removed or whose stone r emoval was postponed to the 
second session were excluded from the study?  
Are patients with choledochal stents removed from the study?  
It is very controversial to say that the cases were included within 2 months, why? Because, in 
patients with gall bladder stones, besides residual stones, the stone from the gall bladder may have 
fallen into the biliary tract.  
A case other than 2 months was excluded: Patients with stones in the gallbladder after ERCP need 
to undergo cholecystectomy within 2 months (if delayed  cholecystectomy).  
Patient selection should be reevaluated.  
Pancreatic duct guidewire placement method (P -GW) The method used for choledochal 
cannulation. However, after choledoch cannulated, GW wire can be removed and ERCP can be 
continued. If necessary, at the end of the procedure, a stent is placed in the pancreatic duct again 
via GW.  
RESULT: Beginning should start traditionally: working year, demographic data etc.  
Incidence and patient characteristics with residual even duct Stones: Only residual stones  were 
detected with CT / MRCP. Maybe the patient's clinic and (  decreasing ,  increasing) bilirubin 
values should also be taken into consideration.  
In multiple logistic regression analysis, performing P -GW was retained as the  
Independent factor of residua l stones (odds ratio [OR], 3.4; 95% CI, 1.1 –9.5; P = 0.02). I respect 
the work result is endless. But I have over 2000 ERCP experience and I personally find this result 
suspicious.  
For residual stone factors: Stone size, processing time, number of stones, characteristics of the 
patient's choledocal anatomy, duodenal diverticulum, insufficient EST, hardness of the stone, and 
others.  
The conclusion should be discussed and reevaluated. It would not be correct to connect the reason 
of the residual stone to P -GW only. The conclusion should be rewritten. Statistical data should be 
reevaluated. All factors affecting residual stone should be determined, whether they are 
meaningful or not.  
I wish you and your work team success.  
 
Reviewer Publication Consent. I agree for my report to be made available under an Ope n 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 e ditor, which will not be 
published.  If you are not happy for us to publish this report, please contact the edi torial office 
before completing the review.  If you wish, you can include your name in your publish ed 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 li cense; please do not publish my name with my report.  
(default)  
Please review this paper.
user
Reviewer ’s report  
 
Title: Pancreatic duct guidewire placement for biliary cannulation as a risk factor for stone residue 
after endoscopic transpapillary stone removal  
 
Version: 0 Date: 01 Jul 2020  
 
Reviewer's report:  
 
Please include all comments for the authors in this bo x rather than uploading 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 wh en adding your comments to the authors.  
 
One of the important for the evaluation of residual stones (except CT, MRCP) is the patient's clinic 
after ERCP. Sometimes we think that we have completely removed the stones, but after ERCP, 
Bilirubin values do not decrease as we want, clinical symptoms continue. This factor is important 
in the evaluation of residual stones.  
In addition, another important factor is the ERCP room equipment, the quality of the device and 
quality cholangiography.  
 
Are the patients whose stone could not be removed or whose stone removal was postponed to the 
second session were excluded from the study?  
Are patients with choledochal stents removed from the study?  
It is very controversial to say that the cases were included within 2 months, w hy? Because, in 
patients with gall bladder stones, besides residual stones, the stone from the gall bladder may have 
fallen into the biliary tract.  
 
A case other than 2 months was excluded: Patients with stones in the gallbladder after ERCP need 
to undergo cholecystectomy within 2 months (if delayed cholecystectomy).  
Patient selection should be reevaluated.  
Pancreatic duct guidewire placement method (P -GW) The method used for choledochal 
cannulation. However, after choledoch cannulated, GW wire can be remove d and ERCP can be 
continued. If necessary, at the end of the procedure, a stent is placed in the pancreatic duct again 
via GW.  
 
RESULT: Beginning should start traditionally: working year, demographic data etc.  
Incidence and patient characteristics with resi dual even duct Stones: Only residual stones were 
detected with CT / MRCP. Maybe the patient's clinic and (  decreasing ,  increasing) bilirubin 
values should also be taken into consideration.  
In multiple logistic regression analysis, performing P -GW was re tained as the  
Independent factor of residual stones (odds ratio [OR], 3.4; 95% CI, 1.1 -9.5; P = 0.02). I respect 
the work result is endless. But I have over 2000 ERCP experience and I personally find this result 
suspicious.  
 
For residual stone factors: Ston e size, processing time, number of stones, characteristics of the 
patient's choledocal anatomy, duodenal diverticulum, insufficient EST, hardness of the stone, and 
others.  
 
The conclusion should be discussed and reevaluated. It would not be correct to conne ct the reason 
of the residual stone to P -GW only. The conclusion should be rewritten. Statistical data should be 
reevaluated. All factors affecting residual stone should be determined, whether they are 
meaningful or not.  
I wish you and your work team succe ss. 
 
Publons Reviewer Recognition . Springer Nature can send verifica tion 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 yo ur new 
profile page. Publons may use the Review Data to generate derivat ive metadata for the benefit of 
Publons and you as a reviewer, carefully considering the sensi tivity of such information. For 
example, Publons may verify your record as a reviewer by u pdatin g your profile published  on its 
webservice if you have registered for such service or help editors t o identify candidate reviewers. 
Please find the details of processing in Publons ’ privacy policy https://publons.com/about/terms  
 
No 
 
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.  
 
No 
 
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 manus cript or would you recommend an additional 
statistical review?  
If an additiona l statistical review is recommended, please speci fy 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 financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financi ally 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 organiz ation 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 th e above, write 'I declare that I have no competing interests' below.  
If your reply is yes to any, please give details below.  
 
One of the important for the evaluation of residual stones (except CT, MRCP) is the patient's clinic 
after ERCP. Sometimes we think that we have completely removed the stones, but after ERCP, 
Bilirubin values do not decrease as we want, clinical symptoms cont inue. This factor is important 
in the evaluation of residual stones.  
In addition, another important factor is the ERCP room equipment, the quality of the device and 
quality cholangiography.  
Are the patients whose stone could not be removed or whose stone r emoval was postponed to the 
second session were excluded from the study?  
Are patients with choledochal stents removed from the study?  
It is very controversial to say that the cases were included within 2 months, why? Because, in 
patients with gall bladder stones, besides residual stones, the stone from the gall bladder may have 
fallen into the biliary tract.  
A case other than 2 months was excluded: Patients with stones in the gallbladder after ERCP need 
to undergo cholecystectomy within 2 months (if delayed  cholecystectomy).  
Patient selection should be reevaluated.  
Pancreatic duct guidewire placement method (P -GW) The method used for choledochal 
cannulation. However, after choledoch cannulated, GW wire can be removed and ERCP can be 
continued. If necessary, at the end of the procedure, a stent is placed in the pancreatic duct again 
via GW.  
RESULT: Beginning should start traditionally: working year, demographic data etc.  
Incidence and patient characteristics with residual even duct Stones: Only residual stones  were 
detected with CT / MRCP. Maybe the patient's clinic and (  decreasing ,  increasing) bilirubin 
values should also be taken into consideration.  
In multiple logistic regression analysis, performing P -GW was retained as the  
Independent factor of residua l stones (odds ratio [OR], 3.4; 95% CI, 1.1 –9.5; P = 0.02). I respect 
the work result is endless. But I have over 2000 ERCP experience and I personally find this result 
suspicious.  
For residual stone factors: Stone size, processing time, number of stones, characteristics of the 
patient's choledocal anatomy, duodenal diverticulum, insufficient EST, hardness of the stone, and 
others.  
The conclusion should be discussed and reevaluated. It would not be correct to connect the reason 
of the residual stone to P -GW only. The conclusion should be rewritten. Statistical data should be 
reevaluated. All factors affecting residual stone should be determined, whether they are 
meaningful or not.  
I wish you and your work team success.  
 
Reviewer Publication Consent. I agree for my report to be made available under an Ope n 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 e ditor, which will not be 
published.  If you are not happy for us to publish this report, please contact the edi torial office 
before completing the review.  If you wish, you can include your name in your publish ed 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 li cense; please do not publish my name with my report.  
(default)  
assistant