Reviewer’ s report
Title: A unique type of fully covered metal stent for the management of post liver transplant
biliary anastomotic strictures
Version: 1Date: 17 Mar 2020
Reviewer: Andrea Anderloni
Reviewer's report:
I've read with great interest the paper by Ben Warner and co-workers entitled "A unique type of
fully covered metal stent for the management of post liver transplant anastomotic strictures" thatreport their experience of treating anastomotic strictures using a novel type of fully covered metalstent (FCSEMS).
In general, the paper is of clinical interest, as it address an important issue of a specific setting of
transplanted patient who develop anastomotic stricture.Despite the use of plastic or metallic stents has already been addressed in several paper, it stilldebatable what kind of endoscopic treatment is the better in case of anastomotic stricture and newdevices are very welcome if they can overcome stent related problems.However, the study has some shortcomings (detailed below) that need to be addressed.1.In the background paragraph the Authors claim that plastic stent have not a good outcome intreating anastomotic stricture. The recent literature (Endo-therapies for biliary duct-to-ductanastomotic stricture after liver transplantation: Outcomes of a nationwide survey. Cantù P et al)have shown that the multistenting technique with plastic stent should be the first line choice in thissetting of patient. Could the Authors expand the discussion about this topic?
2.There is no IRB approval and even if the Authors claim that they have followed the standard
practice, I think this should be done. Moreover: is this a prospective study or just a retrospectiveevaluation of a prospectively collected data base? The Authors should explain.3.The Authors should add a pictures of the stent showing the particular characteristic (such as theantimigration waste) that are not clearly visible in the figures attached.
In conclusion I think that this should be considered as a pilot study on the feasibility of this new
stent.It should be underlined that this results will need to be confirmed in multicentre prospective studybut more important that this kind of approach should be compared with the multistenting plasticone.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assessAre 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 furtherassessment in your comments to the editors.
Not relevant to this manuscriptQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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 thismanuscript, 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 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 reportincluding any attachments I upload will be posted on the website along with the authors'responses. I agree for my report to be made available under an Open Access Creative CommonsCC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any commentswhich I do not wish to be included in my named report can be included as confidential commentsto the editors, which will not be published.
I agree to the open peer review policy of the journal
Reviewer’ s report
Title: A unique type of fully covered metal stent for the management of post liver transplant
biliary anastomotic strictures
Version: 1Date: 17 Mar 2020
Reviewer: Andrea Anderloni
Reviewer's report:
I've read with great interest the paper by Ben Warner and co-workers entitled "A unique type of
fully covered metal stent for the management of post liver transplant anastomotic strictures" thatreport their experience of treating anastomotic strictures using a novel type of fully covered metalstent (FCSEMS).
In general, the paper is of clinical interest, as it address an important issue of a specific setting of
transplanted patient who develop anastomotic stricture.Despite the use of plastic or metallic stents has already been addressed in several paper, it stilldebatable what kind of endoscopic treatment is the better in case of anastomotic stricture and newdevices are very welcome if they can overcome stent related problems.However, the study has some shortcomings (detailed below) that need to be addressed.1.In the background paragraph the Authors claim that plastic stent have not a good outcome intreating anastomotic stricture. The recent literature (Endo-therapies for biliary duct-to-ductanastomotic stricture after liver transplantation: Outcomes of a nationwide survey. Cantù P et al)have shown that the multistenting technique with plastic stent should be the first line choice in thissetting of patient. Could the Authors expand the discussion about this topic?
2.There is no IRB approval and even if the Authors claim that they have followed the standard
practice, I think this should be done. Moreover: is this a prospective study or just a retrospectiveevaluation of a prospectively collected data base? The Authors should explain.3.The Authors should add a pictures of the stent showing the particular characteristic (such as theantimigration waste) that are not clearly visible in the figures attached.
In conclusion I think that this should be considered as a pilot study on the feasibility of this new
stent.It should be underlined that this results will need to be confirmed in multicentre prospective studybut more important that this kind of approach should be compared with the multistenting plasticone.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assessAre 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 furtherassessment in your comments to the editors.
Not relevant to this manuscriptQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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 thismanuscript, 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 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 reportincluding any attachments I upload will be posted on the website along with the authors'responses. I agree for my report to be made available under an Open Access Creative CommonsCC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any commentswhich I do not wish to be included in my named report can be included as confidential commentsto 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: A unique type of fully covered metal stent for the management of post liver transplant
biliary anastomotic strictures
Version: 1Date: 17 Mar 2020
Reviewer: Andrea Anderloni
Reviewer's report:
I've read with great interest the paper by Ben Warner and co-workers entitled "A unique type of
fully covered metal stent for the management of post liver transplant anastomotic strictures" thatreport their experience of treating anastomotic strictures using a novel type of fully covered metalstent (FCSEMS).
In general, the paper is of clinical interest, as it address an important issue of a specific setting of
transplanted patient who develop anastomotic stricture.Despite the use of plastic or metallic stents has already been addressed in several paper, it stilldebatable what kind of endoscopic treatment is the better in case of anastomotic stricture and newdevices are very welcome if they can overcome stent related problems.However, the study has some shortcomings (detailed below) that need to be addressed.1.In the background paragraph the Authors claim that plastic stent have not a good outcome intreating anastomotic stricture. The recent literature (Endo-therapies for biliary duct-to-ductanastomotic stricture after liver transplantation: Outcomes of a nationwide survey. Cantù P et al)have shown that the multistenting technique with plastic stent should be the first line choice in thissetting of patient. Could the Authors expand the discussion about this topic?
2.There is no IRB approval and even if the Authors claim that they have followed the standard
practice, I think this should be done. Moreover: is this a prospective study or just a retrospectiveevaluation of a prospectively collected data base? The Authors should explain.3.The Authors should add a pictures of the stent showing the particular characteristic (such as theantimigration waste) that are not clearly visible in the figures attached.
In conclusion I think that this should be considered as a pilot study on the feasibility of this new
stent.It should be underlined that this results will need to be confirmed in multicentre prospective studybut more important that this kind of approach should be compared with the multistenting plasticone.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assessAre 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 furtherassessment in your comments to the editors.
Not relevant to this manuscriptQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration 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 thismanuscript, 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 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 reportincluding any attachments I upload will be posted on the website along with the authors'responses. I agree for my report to be made available under an Open Access Creative CommonsCC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any commentswhich I do not wish to be included in my named report can be included as confidential commentsto the editors, which will not be published.
I agree to the open peer review policy of the journal
assistant