Reviewer's report
Title:Ectopic papilla in the duodenal bulb and duodenal stenosis: an overlooked
association with clinical, diagnostic and therapeutic implications
Version: 2Date:13 August 2010
Reviewer: Attila Csendes
Reviewer's report:
1.- Define clearly what do you mean by ectopic opening of the CBD into the
duodenal bulb.
a.- in which portion of the duodenal bulb?
b.- what happens with Wirsung and Santonini ducts’
2.- Instead of “There is” it should be “there are few reports”.
3.- Instead of “subject” say “topic”.
4.- It is not clear why male predominance means genetic abnormality.
5.- This reviewer with a personal experience of over 20.000 patients with
gallstones or common bile duct stones has never seen such an anomaly. How
could you diagnose this very rare entity in 96 patients in less than 4 years?
Methods
1.- This is a retrospective analysis and should be clearly stated as so.
2.- If there was a stenosis which did not allow to pass the duodenoscope, how
could you see no evidence of papilla structure in the second or third portion?
3.- What do you mean by “duodenoscope was replaced with a diagnostic one”?
What does it mean?
4.- What do you mean by patients with simple gastroenterostomy? Why was
done this surgical procedure?
5.- How did you know that a Billroth II patient or gastroenterostomy patient had
an ectopic opening of the CBD? In Billroth II patients the duodenal bulb is usually
excised.
Results
1.- How many patients had gallstones?
2.- What do you mean by “operation” biliary problem in table 1?
What is jaundice to roule out?
3.- If 71/74 patients had choledocholithiasis, what happened at the gallbladder?
4.- There was no complication after ERCP?
Discussion
1.- All hypothesis concerning development of duodenal ulcer are completely
wrong. The bicarbonate of the pancreatic juice has never favored recurrent
duodenal ulcer.
2.- Why do you state that presence of pancreatic secretion and bile are
necessary for the development of deformities ulcer and stenosis if in the normal
position in every human being this never occurs?
Reviewer's report
Title:Ectopic papilla in the duodenal bulb and duodenal stenosis: an overlooked
association with clinical, diagnostic and therapeutic implications
Version: 2Date:13 August 2010
Reviewer: Attila Csendes
Reviewer's report:
1.- Define clearly what do you mean by ectopic opening of the CBD into the
duodenal bulb.
a.- in which portion of the duodenal bulb?
b.- what happens with Wirsung and Santonini ducts’
2.- Instead of “There is” it should be “there are few reports”.
3.- Instead of “subject” say “topic”.
4.- It is not clear why male predominance means genetic abnormality.
5.- This reviewer with a personal experience of over 20.000 patients with
gallstones or common bile duct stones has never seen such an anomaly. How
could you diagnose this very rare entity in 96 patients in less than 4 years?
Methods
1.- This is a retrospective analysis and should be clearly stated as so.
2.- If there was a stenosis which did not allow to pass the duodenoscope, how
could you see no evidence of papilla structure in the second or third portion?
3.- What do you mean by “duodenoscope was replaced with a diagnostic one”?
What does it mean?
4.- What do you mean by patients with simple gastroenterostomy? Why was
done this surgical procedure?
5.- How did you know that a Billroth II patient or gastroenterostomy patient had
an ectopic opening of the CBD? In Billroth II patients the duodenal bulb is usually
excised.
Results
1.- How many patients had gallstones?
2.- What do you mean by “operation” biliary problem in table 1?
What is jaundice to roule out?
3.- If 71/74 patients had choledocholithiasis, what happened at the gallbladder?
4.- There was no complication after ERCP?
Discussion
1.- All hypothesis concerning development of duodenal ulcer are completely
wrong. The bicarbonate of the pancreatic juice has never favored recurrent
duodenal ulcer.
2.- Why do you state that presence of pancreatic secretion and bile are
necessary for the development of deformities ulcer and stenosis if in the normal
position in every human being this never occurs?
Please review this paper.
user
Reviewer's report
Title:Ectopic papilla in the duodenal bulb and duodenal stenosis: an overlooked
association with clinical, diagnostic and therapeutic implications
Version: 2Date:13 August 2010
Reviewer: Attila Csendes
Reviewer's report:
1.- Define clearly what do you mean by ectopic opening of the CBD into the
duodenal bulb.
a.- in which portion of the duodenal bulb?
b.- what happens with Wirsung and Santonini ducts’
2.- Instead of “There is” it should be “there are few reports”.
3.- Instead of “subject” say “topic”.
4.- It is not clear why male predominance means genetic abnormality.
5.- This reviewer with a personal experience of over 20.000 patients with
gallstones or common bile duct stones has never seen such an anomaly. How
could you diagnose this very rare entity in 96 patients in less than 4 years?
Methods
1.- This is a retrospective analysis and should be clearly stated as so.
2.- If there was a stenosis which did not allow to pass the duodenoscope, how
could you see no evidence of papilla structure in the second or third portion?
3.- What do you mean by “duodenoscope was replaced with a diagnostic one”?
What does it mean?
4.- What do you mean by patients with simple gastroenterostomy? Why was
done this surgical procedure?
5.- How did you know that a Billroth II patient or gastroenterostomy patient had
an ectopic opening of the CBD? In Billroth II patients the duodenal bulb is usually
excised.
Results
1.- How many patients had gallstones?
2.- What do you mean by “operation” biliary problem in table 1?
What is jaundice to roule out?
3.- If 71/74 patients had choledocholithiasis, what happened at the gallbladder?
4.- There was no complication after ERCP?
Discussion
1.- All hypothesis concerning development of duodenal ulcer are completely
wrong. The bicarbonate of the pancreatic juice has never favored recurrent
duodenal ulcer.
2.- Why do you state that presence of pancreatic secretion and bile are
necessary for the development of deformities ulcer and stenosis if in the normal
position in every human being this never occurs?
assistant