Title: Biliary obstruction and pancreatitis after duodenal stent placement in the descending
duodenum: a retrospective study
Version: 2 Date: 28 Mar 2022
Reviewer's report:
This is a review of manuscript No. 4d85c09a-908f-4685-a20a-2466ae269578, entitled " Acute
cholangitis and pancreatitis after duodenal stent placement in the descending duodenum: a
retrospective study" Though it is interesting, there are still many points that need to be revised.
Major Comments:
Conditions that cause stenosis in the descending duodenum are often complicated by bile
duct stricture. This is a condition that requires conquering two problems. Although this is an
important issue to consider, there is insufficient information and the content does not provide
a vision of actual clinical practice.
Cholangitis often requires drainage, while pancreatitis is treated conservatively. Considering
these two different invasive diseases together may obscure the issue. In fact, this manuscript
provides a solid discussion of bile duct drainage before and after DSP, but the inclusion of cases
of pancreatitis in the statistics diminishes the significance of the results of the study.
We suggest a little more focus on duodenal stenting and cholangitis.
Minor comments
1) Page3, line51
Throughout the manuscript, only “SEMS” is used for both biliary and duodenal, making it
difficult to understand the meaning of the text at times.
2) Page5, line80
Both Covered and Uncovered duodenal stents have been incorporated into the study. These two
types of stents have sometimes been subjected to comparative studies. The number of cases in
which Covered SEMS was actually used was small. It is suggested that Covered SEMS cases
be excluded from this study.
3) Page6, line103
Although the report mentions the presence of a bile duct stent, the bile duct stent is a device for
which TRBO after implantation is discussed. If cholangitis triggered by DSP is to be discussed,
a bile duct stent that was originally nearly obstructed should be excluded, and at least the period
of time that has elapsed since implantation should be noted. Since the onset of cholangitis leads
to withdrawal of chemotherapy, the bile duct stent may undergo periodic replacement.
4) Page8, line136
How about charting the Study enrolment.
5) Page8, line141
Any abnormal values in biliary enzymes prior to DSP should be noted.
6) Page10, line176
It should state "First,...,before DSP."
7) Page10, line180
This study evaluates short-term AEs. What is the long-term prognosis for patients with DSP
only, without prophylactic bile duct stenting?
8) Page11, line191
It is unclear why the creation of space would lead to pressure on the main papilla. A more
detailed description is requested.
Title: Biliary obstruction and pancreatitis after duodenal stent placement in the descending
duodenum: a retrospective study
Version: 2 Date: 28 Mar 2022
Reviewer's report:
This is a review of manuscript No. 4d85c09a-908f-4685-a20a-2466ae269578, entitled " Acute
cholangitis and pancreatitis after duodenal stent placement in the descending duodenum: a
retrospective study" Though it is interesting, there are still many points that need to be revised.
Major Comments:
Conditions that cause stenosis in the descending duodenum are often complicated by bile
duct stricture. This is a condition that requires conquering two problems. Although this is an
important issue to consider, there is insufficient information and the content does not provide
a vision of actual clinical practice.
Cholangitis often requires drainage, while pancreatitis is treated conservatively. Considering
these two different invasive diseases together may obscure the issue. In fact, this manuscript
provides a solid discussion of bile duct drainage before and after DSP, but the inclusion of cases
of pancreatitis in the statistics diminishes the significance of the results of the study.
We suggest a little more focus on duodenal stenting and cholangitis.
Minor comments
1) Page3, line51
Throughout the manuscript, only “SEMS” is used for both biliary and duodenal, making it
difficult to understand the meaning of the text at times.
2) Page5, line80
Both Covered and Uncovered duodenal stents have been incorporated into the study. These two
types of stents have sometimes been subjected to comparative studies. The number of cases in
which Covered SEMS was actually used was small. It is suggested that Covered SEMS cases
be excluded from this study.
3) Page6, line103
Although the report mentions the presence of a bile duct stent, the bile duct stent is a device for
which TRBO after implantation is discussed. If cholangitis triggered by DSP is to be discussed,
a bile duct stent that was originally nearly obstructed should be excluded, and at least the period
of time that has elapsed since implantation should be noted. Since the onset of cholangitis leads
to withdrawal of chemotherapy, the bile duct stent may undergo periodic replacement.
4) Page8, line136
How about charting the Study enrolment.
5) Page8, line141
Any abnormal values in biliary enzymes prior to DSP should be noted.
6) Page10, line176
It should state "First,...,before DSP."
7) Page10, line180
This study evaluates short-term AEs. What is the long-term prognosis for patients with DSP
only, without prophylactic bile duct stenting?
8) Page11, line191
It is unclear why the creation of space would lead to pressure on the main papilla. A more
detailed description is requested.
Please review this paper.
user
Title: Biliary obstruction and pancreatitis after duodenal stent placement in the descending
duodenum: a retrospective study
Version: 2 Date: 28 Mar 2022
Reviewer's report:
This is a review of manuscript No. 4d85c09a-908f-4685-a20a-2466ae269578, entitled " Acute
cholangitis and pancreatitis after duodenal stent placement in the descending duodenum: a
retrospective study" Though it is interesting, there are still many points that need to be revised.
Major Comments:
Conditions that cause stenosis in the descending duodenum are often complicated by bile
duct stricture. This is a condition that requires conquering two problems. Although this is an
important issue to consider, there is insufficient information and the content does not provide
a vision of actual clinical practice.
Cholangitis often requires drainage, while pancreatitis is treated conservatively. Considering
these two different invasive diseases together may obscure the issue. In fact, this manuscript
provides a solid discussion of bile duct drainage before and after DSP, but the inclusion of cases
of pancreatitis in the statistics diminishes the significance of the results of the study.
We suggest a little more focus on duodenal stenting and cholangitis.
Minor comments
1) Page3, line51
Throughout the manuscript, only “SEMS” is used for both biliary and duodenal, making it
difficult to understand the meaning of the text at times.
2) Page5, line80
Both Covered and Uncovered duodenal stents have been incorporated into the study. These two
types of stents have sometimes been subjected to comparative studies. The number of cases in
which Covered SEMS was actually used was small. It is suggested that Covered SEMS cases
be excluded from this study.
3) Page6, line103
Although the report mentions the presence of a bile duct stent, the bile duct stent is a device for
which TRBO after implantation is discussed. If cholangitis triggered by DSP is to be discussed,
a bile duct stent that was originally nearly obstructed should be excluded, and at least the period
of time that has elapsed since implantation should be noted. Since the onset of cholangitis leads
to withdrawal of chemotherapy, the bile duct stent may undergo periodic replacement.
4) Page8, line136
How about charting the Study enrolment.
5) Page8, line141
Any abnormal values in biliary enzymes prior to DSP should be noted.
6) Page10, line176
It should state "First,...,before DSP."
7) Page10, line180
This study evaluates short-term AEs. What is the long-term prognosis for patients with DSP
only, without prophylactic bile duct stenting?
8) Page11, line191
It is unclear why the creation of space would lead to pressure on the main papilla. A more
detailed description is requested.
assistant