Reviewer ’s report  
 
Title: The H.O.U.S.E. Classification: A novel endoscopic retrograde cholangiopancreatography 
(ERCP) complexity grading scale.  
 
Version: 1 Date: 10 Aug 2016 
 
Reviewer:  Amy  Tyberg  
 
Reviewer’s report:  
 
Thank you for your responses. A few additional comments:  
 
1. Although in your response you acknowledge that the scoring system cannot be used as a tool 
to triage more complex ERCPs to tertiary centers since many of the criteria are unknown unt il 
the procedure is being performed, the discussion still states in several places that this system can 
be used for triaging. For example:  
 
" Thismakes the HOUSE score suitable as an instrument to iden tify complex ERCP procedures 
in advance where prophyla ctic actions may have the potential to lower postoperative  
complication rates. "  
 
I don't believe this conclusion can be drawn unless the peri -procedural criteria are excluded.  
 
2. In your response, you say that although there is more pre -procedure panc reatitis in House 
groups 1 and 2, it is not a statistically significant difference. I think this is important to mention 
this in the manuscript as part of the results section.  
 
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.  
 
No 
 
Are you able to assess any sta tistics 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 editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 
financial ly 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 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 in 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.  
 
I declare that I have no competing interests.  
 
I agree to the open peer 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 authors' 
responses. I agree for my report to be made available unde r an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do 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 H.O.U.S.E. Classification: A novel endoscopic retrograde cholangiopancreatography 
(ERCP) complexity grading scale.  
 
Version: 1 Date: 10 Aug 2016 
 
Reviewer:  Amy  Tyberg  
 
Reviewer’s report:  
 
Thank you for your responses. A few additional comments:  
 
1. Although in your response you acknowledge that the scoring system cannot be used as a tool 
to triage more complex ERCPs to tertiary centers since many of the criteria are unknown unt il 
the procedure is being performed, the discussion still states in several places that this system can 
be used for triaging. For example:  
 
" Thismakes the HOUSE score suitable as an instrument to iden tify complex ERCP procedures 
in advance where prophyla ctic actions may have the potential to lower postoperative  
complication rates. "  
 
I don't believe this conclusion can be drawn unless the peri -procedural criteria are excluded.  
 
2. In your response, you say that although there is more pre -procedure panc reatitis in House 
groups 1 and 2, it is not a statistically significant difference. I think this is important to mention 
this in the manuscript as part of the results section.  
 
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.  
 
No 
 
Are you able to assess any sta tistics 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 editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 
financial ly 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 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 in 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.  
 
I declare that I have no competing interests.  
 
I agree to the open peer 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 authors' 
responses. I agree for my report to be made available unde r an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do 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 H.O.U.S.E. Classification: A novel endoscopic retrograde cholangiopancreatography 
(ERCP) complexity grading scale.  
 
Version: 1 Date: 10 Aug 2016 
 
Reviewer:  Amy  Tyberg  
 
Reviewer’s report:  
 
Thank you for your responses. A few additional comments:  
 
1. Although in your response you acknowledge that the scoring system cannot be used as a tool 
to triage more complex ERCPs to tertiary centers since many of the criteria are unknown unt il 
the procedure is being performed, the discussion still states in several places that this system can 
be used for triaging. For example:  
 
" Thismakes the HOUSE score suitable as an instrument to iden tify complex ERCP procedures 
in advance where prophyla ctic actions may have the potential to lower postoperative  
complication rates. "  
 
I don't believe this conclusion can be drawn unless the peri -procedural criteria are excluded.  
 
2. In your response, you say that although there is more pre -procedure panc reatitis in House 
groups 1 and 2, it is not a statistically significant difference. I think this is important to mention 
this in the manuscript as part of the results section.  
 
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.  
 
No 
 
Are you able to assess any sta tistics 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 editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 
financial ly 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 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 in 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.  
 
I declare that I have no competing interests.  
 
I agree to the open peer 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 authors' 
responses. I agree for my report to be made available unde r an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do 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