Title: Biliary obstruction and pancreatitis after duodenal stent placement in the descending
duodenum: a retrospective study
Version: 2 Date: 02 Apr 2022
Reviewer's report:
The authors retrospectively evaluated the risk factors for acute cholangitis and/or pancreatitis
after duodenal stent placement in the descending duodenum. The multivariate analysis indicated
that female sex, absence of biliary stents, and tumor invasion to the major duodenal papilla
were significant independent risk factors for acute cholangitis and/or pancreatitis. This study is
useful for the readers who manage malignant gastric outlet obstruction (GOO). I have several
comments for the authors.
Major
1. Sixty-five patients who underwent duodenal SEMS placement in the descending duodenum
were enrolled in this study. Were major duodenal papilla covered with duodenal SEMS in all
65 patients?
2. Thirty-four patients underwent biliary stent placement in this study. What were the intervals
between biliary stent placement and duodenal SEMS placement? Were there any patients who
underwent both biliary stent and duodenal SEMS placement on the same day? The incidences
of pancreatitis might be affected by the placement of biliary stent placement on the same day.
3. What is the length of biliary SEMS in the duodenal portion (distal side of biliary SEMS in
the D2) in the authors’ institution?
4. How did the authors treat the patients with both biliary obstruction and GOO in this study?
Which one of these 4 methods is these patients applicable to?
A) Biliary stent to Duodenal SEMS on separate days
B) Biliary stent to Duodenal SEMS on the same day
C) Duodenal SEMS to EUS-BD on separate days
D) Duodenal SEMS to EUS-BD on the same day
5. Eleven cholangitis after duodenal SEMS placement was observed in this study. Three patients
were treated with antibiotic therapy alone, and six underwent biliary drainage along with
antibiotic administration. How did the authors select conservative or interventional therapy?
Could PTBD tube be removed after the improvement of cholangitis in three PTBD cases?
6. The number of events (acute cholangitis and/or pancreatitis) is eleven. The authors evaluated
4 variables in multivariate analysis. The number of events might be insufficient for multivariate
analysis.
Minor
1. Did the authors obtain histological evidence in all 65 patients?
Title: Biliary obstruction and pancreatitis after duodenal stent placement in the descending
duodenum: a retrospective study
Version: 2 Date: 02 Apr 2022
Reviewer's report:
The authors retrospectively evaluated the risk factors for acute cholangitis and/or pancreatitis
after duodenal stent placement in the descending duodenum. The multivariate analysis indicated
that female sex, absence of biliary stents, and tumor invasion to the major duodenal papilla
were significant independent risk factors for acute cholangitis and/or pancreatitis. This study is
useful for the readers who manage malignant gastric outlet obstruction (GOO). I have several
comments for the authors.
Major
1. Sixty-five patients who underwent duodenal SEMS placement in the descending duodenum
were enrolled in this study. Were major duodenal papilla covered with duodenal SEMS in all
65 patients?
2. Thirty-four patients underwent biliary stent placement in this study. What were the intervals
between biliary stent placement and duodenal SEMS placement? Were there any patients who
underwent both biliary stent and duodenal SEMS placement on the same day? The incidences
of pancreatitis might be affected by the placement of biliary stent placement on the same day.
3. What is the length of biliary SEMS in the duodenal portion (distal side of biliary SEMS in
the D2) in the authors’ institution?
4. How did the authors treat the patients with both biliary obstruction and GOO in this study?
Which one of these 4 methods is these patients applicable to?
A) Biliary stent to Duodenal SEMS on separate days
B) Biliary stent to Duodenal SEMS on the same day
C) Duodenal SEMS to EUS-BD on separate days
D) Duodenal SEMS to EUS-BD on the same day
5. Eleven cholangitis after duodenal SEMS placement was observed in this study. Three patients
were treated with antibiotic therapy alone, and six underwent biliary drainage along with
antibiotic administration. How did the authors select conservative or interventional therapy?
Could PTBD tube be removed after the improvement of cholangitis in three PTBD cases?
6. The number of events (acute cholangitis and/or pancreatitis) is eleven. The authors evaluated
4 variables in multivariate analysis. The number of events might be insufficient for multivariate
analysis.
Minor
1. Did the authors obtain histological evidence in all 65 patients?
Please review this paper.
user
Title: Biliary obstruction and pancreatitis after duodenal stent placement in the descending
duodenum: a retrospective study
Version: 2 Date: 02 Apr 2022
Reviewer's report:
The authors retrospectively evaluated the risk factors for acute cholangitis and/or pancreatitis
after duodenal stent placement in the descending duodenum. The multivariate analysis indicated
that female sex, absence of biliary stents, and tumor invasion to the major duodenal papilla
were significant independent risk factors for acute cholangitis and/or pancreatitis. This study is
useful for the readers who manage malignant gastric outlet obstruction (GOO). I have several
comments for the authors.
Major
1. Sixty-five patients who underwent duodenal SEMS placement in the descending duodenum
were enrolled in this study. Were major duodenal papilla covered with duodenal SEMS in all
65 patients?
2. Thirty-four patients underwent biliary stent placement in this study. What were the intervals
between biliary stent placement and duodenal SEMS placement? Were there any patients who
underwent both biliary stent and duodenal SEMS placement on the same day? The incidences
of pancreatitis might be affected by the placement of biliary stent placement on the same day.
3. What is the length of biliary SEMS in the duodenal portion (distal side of biliary SEMS in
the D2) in the authors’ institution?
4. How did the authors treat the patients with both biliary obstruction and GOO in this study?
Which one of these 4 methods is these patients applicable to?
A) Biliary stent to Duodenal SEMS on separate days
B) Biliary stent to Duodenal SEMS on the same day
C) Duodenal SEMS to EUS-BD on separate days
D) Duodenal SEMS to EUS-BD on the same day
5. Eleven cholangitis after duodenal SEMS placement was observed in this study. Three patients
were treated with antibiotic therapy alone, and six underwent biliary drainage along with
antibiotic administration. How did the authors select conservative or interventional therapy?
Could PTBD tube be removed after the improvement of cholangitis in three PTBD cases?
6. The number of events (acute cholangitis and/or pancreatitis) is eleven. The authors evaluated
4 variables in multivariate analysis. The number of events might be insufficient for multivariate
analysis.
Minor
1. Did the authors obtain histological evidence in all 65 patients?
assistant