Reviewer's report
Title:Endoscopic stenting for hilar cholangiocarcinoma: Efficacy of unilateral and
bilateral placement of plastic and metal stents in a retrospective review of 480
patients
Version: 1Date:13 June 2012
Reviewer: Nicholas church
Reviewer's report:
General
This is a well written and presented paper documenting impressive outcomes for
endoscopic stenting of hilar tumours. The background and aims are clearly
stated, the methods and techniques well described, and the conclusions
supported by the data presented. The authors acknowledge that the
retrospective nature of the study over a 15 year period with a resultant variability
in materials and techniques is the major limitation of the work. I would agree that
prospective randomised controlled trials are needed in this area and that this
study would support the performance of such trials.
Major compulsory revisions
None
Minor essential revisions
The legend relating to the figures corresponds with the text. However, the
labelling on the images themselves does not correspond with the legend.
Discretionary revisions
1. A recent randomised controlled trial comparing outcomes of plastic and metal
stents in complex hilar strictures is in press (Sangchan A, Kongkasame W,
Pugkhem A, Jenwitheesuk K, Mairiang P. Efficacy of metal and plastic stents in
unresectable complex hilar cholangiocarcinoma: a randomized controlled trial.
Gastrointest Endosc. 2012 May 15. [Epub ahead of print]) The discussion would
benefit from the inclusion of the results of this trial, which demonstrated superior
outcomes in patients treated with metal stents both in terms of success of
drainage and survival.
2. Although this study demonstrated improvements in technical and clinical
success rates of biliary drainage for SEMS along with lower complication rates
and longer cumulative stent patency, this did not translate into a survival benefit.
The paper would be strengthened by a more comprehensive discussion of this
aspect. Were there any data available regarding quality of life in the different
groups? In addition it would be useful to consider or suggest a cost/benefit
analysis, taking into account length of hospital stay, re-admission and
re-intervention rates for the two stenting methods.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Endoscopic stenting for hilar cholangiocarcinoma: Efficacy of unilateral and
bilateral placement of plastic and metal stents in a retrospective review of 480
patients
Version: 1Date:13 June 2012
Reviewer: Nicholas church
Reviewer's report:
General
This is a well written and presented paper documenting impressive outcomes for
endoscopic stenting of hilar tumours. The background and aims are clearly
stated, the methods and techniques well described, and the conclusions
supported by the data presented. The authors acknowledge that the
retrospective nature of the study over a 15 year period with a resultant variability
in materials and techniques is the major limitation of the work. I would agree that
prospective randomised controlled trials are needed in this area and that this
study would support the performance of such trials.
Major compulsory revisions
None
Minor essential revisions
The legend relating to the figures corresponds with the text. However, the
labelling on the images themselves does not correspond with the legend.
Discretionary revisions
1. A recent randomised controlled trial comparing outcomes of plastic and metal
stents in complex hilar strictures is in press (Sangchan A, Kongkasame W,
Pugkhem A, Jenwitheesuk K, Mairiang P. Efficacy of metal and plastic stents in
unresectable complex hilar cholangiocarcinoma: a randomized controlled trial.
Gastrointest Endosc. 2012 May 15. [Epub ahead of print]) The discussion would
benefit from the inclusion of the results of this trial, which demonstrated superior
outcomes in patients treated with metal stents both in terms of success of
drainage and survival.
2. Although this study demonstrated improvements in technical and clinical
success rates of biliary drainage for SEMS along with lower complication rates
and longer cumulative stent patency, this did not translate into a survival benefit.
The paper would be strengthened by a more comprehensive discussion of this
aspect. Were there any data available regarding quality of life in the different
groups? In addition it would be useful to consider or suggest a cost/benefit
analysis, taking into account length of hospital stay, re-admission and
re-intervention rates for the two stenting methods.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Endoscopic stenting for hilar cholangiocarcinoma: Efficacy of unilateral and
bilateral placement of plastic and metal stents in a retrospective review of 480
patients
Version: 1Date:13 June 2012
Reviewer: Nicholas church
Reviewer's report:
General
This is a well written and presented paper documenting impressive outcomes for
endoscopic stenting of hilar tumours. The background and aims are clearly
stated, the methods and techniques well described, and the conclusions
supported by the data presented. The authors acknowledge that the
retrospective nature of the study over a 15 year period with a resultant variability
in materials and techniques is the major limitation of the work. I would agree that
prospective randomised controlled trials are needed in this area and that this
study would support the performance of such trials.
Major compulsory revisions
None
Minor essential revisions
The legend relating to the figures corresponds with the text. However, the
labelling on the images themselves does not correspond with the legend.
Discretionary revisions
1. A recent randomised controlled trial comparing outcomes of plastic and metal
stents in complex hilar strictures is in press (Sangchan A, Kongkasame W,
Pugkhem A, Jenwitheesuk K, Mairiang P. Efficacy of metal and plastic stents in
unresectable complex hilar cholangiocarcinoma: a randomized controlled trial.
Gastrointest Endosc. 2012 May 15. [Epub ahead of print]) The discussion would
benefit from the inclusion of the results of this trial, which demonstrated superior
outcomes in patients treated with metal stents both in terms of success of
drainage and survival.
2. Although this study demonstrated improvements in technical and clinical
success rates of biliary drainage for SEMS along with lower complication rates
and longer cumulative stent patency, this did not translate into a survival benefit.
The paper would be strengthened by a more comprehensive discussion of this
aspect. Were there any data available regarding quality of life in the different
groups? In addition it would be useful to consider or suggest a cost/benefit
analysis, taking into account length of hospital stay, re-admission and
re-intervention rates for the two stenting methods.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
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