Reviewer ’s report  
 
Title:  The modified pancreatic stent system for prevention of post -ERCP pancre atitis: a case -
control study  
 
Version: 0 Date: 22 Aug 2016 
 
Reviewer:  Mohamed  Othman  
 
Reviewer’s report:  
 
This is a case control study comparing placement of standard pancreatic duct stent to a new 
version of pancreatic stent which is attached to nasobiliary drain. The new version of pancreatic 
duct stent had less proximal migration  rate and low rate of spontaneous distal migration. In 
addition the new system could be removed with pulling the nasobiliary drain (since the stent is 
attached to it with wire) under x ray guidance without the need for endoscopy.   
 
I commend the authors o n their efforts and on writing a clear and organized manuscript.  
 
 
Major concerns:  
 
1- Although the study reported outcomes regarding the successfulness of stent placement, 
rates of proximal and distal migration, there was no data in regards to patient toler ability and 
pain control. Leaving a nasobiliary drain for one week might cause nasal irritation and is 
associated with increase discomfort. Also, this system limit the use of this pancreatic stent to  
patients in which nasobiliary drain is placed. Overall,  western endoscopists are trying to get 
away from the habit of placing nasobiliary drains giving the increase in patients' discomfort.  
 
2- The term "improved pancreatic stent system" is to somewhat implies it is better than the 
original pancreatic stent. A lso the study presents data to support this claim, the data is not 
sufficient to claim superiority giving concerns cited above. I would suggested changed it to " a 
modified pancreatic stent system' or something similar.  
 
3- The authors did not explain how p atients were allocated to each of the included groups.  
 
 
Minor concerns:  
 
1- How many patients in the ordinary group had biliary drain?  
 
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.  
 
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 recommended, please specify what aspects require further 
assessment in your comments to the edit ors. 
 
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 re ceived 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 i n 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 
I agree to the open pe er 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 publication, my named report 
including any attachments I upload will be posted on the website along with the auth ors' 
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 d o 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:  The modified pancreatic stent system for prevention of post -ERCP pancre atitis: a case -
control study  
 
Version: 0 Date: 22 Aug 2016 
 
Reviewer:  Mohamed  Othman  
 
Reviewer’s report:  
 
This is a case control study comparing placement of standard pancreatic duct stent to a new 
version of pancreatic stent which is attached to nasobiliary drain. The new version of pancreatic 
duct stent had less proximal migration  rate and low rate of spontaneous distal migration. In 
addition the new system could be removed with pulling the nasobiliary drain (since the stent is 
attached to it with wire) under x ray guidance without the need for endoscopy.   
 
I commend the authors o n their efforts and on writing a clear and organized manuscript.  
 
 
Major concerns:  
 
1- Although the study reported outcomes regarding the successfulness of stent placement, 
rates of proximal and distal migration, there was no data in regards to patient toler ability and 
pain control. Leaving a nasobiliary drain for one week might cause nasal irritation and is 
associated with increase discomfort. Also, this system limit the use of this pancreatic stent to  
patients in which nasobiliary drain is placed. Overall,  western endoscopists are trying to get 
away from the habit of placing nasobiliary drains giving the increase in patients' discomfort.  
 
2- The term "improved pancreatic stent system" is to somewhat implies it is better than the 
original pancreatic stent. A lso the study presents data to support this claim, the data is not 
sufficient to claim superiority giving concerns cited above. I would suggested changed it to " a 
modified pancreatic stent system' or something similar.  
 
3- The authors did not explain how p atients were allocated to each of the included groups.  
 
 
Minor concerns:  
 
1- How many patients in the ordinary group had biliary drain?  
 
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.  
 
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 recommended, please specify what aspects require further 
assessment in your comments to the edit ors. 
 
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 re ceived 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 i n 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 
I agree to the open pe er 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 publication, my named report 
including any attachments I upload will be posted on the website along with the auth ors' 
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 d o 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:  The modified pancreatic stent system for prevention of post -ERCP pancre atitis: a case -
control study  
 
Version: 0 Date: 22 Aug 2016 
 
Reviewer:  Mohamed  Othman  
 
Reviewer’s report:  
 
This is a case control study comparing placement of standard pancreatic duct stent to a new 
version of pancreatic stent which is attached to nasobiliary drain. The new version of pancreatic 
duct stent had less proximal migration  rate and low rate of spontaneous distal migration. In 
addition the new system could be removed with pulling the nasobiliary drain (since the stent is 
attached to it with wire) under x ray guidance without the need for endoscopy.   
 
I commend the authors o n their efforts and on writing a clear and organized manuscript.  
 
 
Major concerns:  
 
1- Although the study reported outcomes regarding the successfulness of stent placement, 
rates of proximal and distal migration, there was no data in regards to patient toler ability and 
pain control. Leaving a nasobiliary drain for one week might cause nasal irritation and is 
associated with increase discomfort. Also, this system limit the use of this pancreatic stent to  
patients in which nasobiliary drain is placed. Overall,  western endoscopists are trying to get 
away from the habit of placing nasobiliary drains giving the increase in patients' discomfort.  
 
2- The term "improved pancreatic stent system" is to somewhat implies it is better than the 
original pancreatic stent. A lso the study presents data to support this claim, the data is not 
sufficient to claim superiority giving concerns cited above. I would suggested changed it to " a 
modified pancreatic stent system' or something similar.  
 
3- The authors did not explain how p atients were allocated to each of the included groups.  
 
 
Minor concerns:  
 
1- How many patients in the ordinary group had biliary drain?  
 
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.  
 
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 recommended, please specify what aspects require further 
assessment in your comments to the edit ors. 
 
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 re ceived 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 i n 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 
I agree to the open pe er 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 publication, my named report 
including any attachments I upload will be posted on the website along with the auth ors' 
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 d o 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