Reviewer ’s report  
 
Title: Double -catheter lavage combined with percutaneous flexible endoscopic debridement for  
infected pancreatic necrosis failed to percutaneous catheter dr ainage  
 
Version: 0 Date: 12 Jun 2017  
 
Reviewer: Robert Sutton  
 
Reviewer's report:  
 
This study provides retrospective data comparing the outcomes of patients with pancreatic 
necrosis managed either by perc utaneous minimally invasive or open necrosectomy. The data 
suggest improved outcomes over that obtained with open necrosectomy by insertion of a drain 
then one week later by opening the track to pass a 'double catheter' for irrigation lavage, followed 
by p ercutaneous flexible endoscopic debridement. The use of the 'double catheter' is a slight 
modification of previously reported methods that might be interpreted as a delaying tactic 
allowing some local resolution prior to formal debridement. The use of a fl exible endoscope is 
well described for per -oral endoscopic debridement of pancreatic necrosis through stents inserted 
via the stomach into the necrosis, but not well described as used here. Although the series is 
small, there is merit in replication of the  finding that minimal access approaches confer 
advantages over the open approach. The 'double catheter' should be properly described as it will 
be confused with a 'double lumen catheter' which is far commoner. The methods section should 
make clear that the  study is retrospective, rather than appearing to be prospective or written in 
the format of what one might expect to be prospective.  
 
 
 
 
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 t he 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.  
 
Yes 
 
 
Are you able to ass ess 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 further  
assessment in your comments to the editors.  
 
I am able to assess th e 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 t he 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  
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 o f 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.  
 
No competing interests  
 
I agree to th e 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 under 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: Double -catheter lavage combined with percutaneous flexible endoscopic debridement for  
infected pancreatic necrosis failed to percutaneous catheter dr ainage  
 
Version: 0 Date: 12 Jun 2017  
 
Reviewer: Robert Sutton  
 
Reviewer's report:  
 
This study provides retrospective data comparing the outcomes of patients with pancreatic 
necrosis managed either by perc utaneous minimally invasive or open necrosectomy. The data 
suggest improved outcomes over that obtained with open necrosectomy by insertion of a drain 
then one week later by opening the track to pass a 'double catheter' for irrigation lavage, followed 
by p ercutaneous flexible endoscopic debridement. The use of the 'double catheter' is a slight 
modification of previously reported methods that might be interpreted as a delaying tactic 
allowing some local resolution prior to formal debridement. The use of a fl exible endoscope is 
well described for per -oral endoscopic debridement of pancreatic necrosis through stents inserted 
via the stomach into the necrosis, but not well described as used here. Although the series is 
small, there is merit in replication of the  finding that minimal access approaches confer 
advantages over the open approach. The 'double catheter' should be properly described as it will 
be confused with a 'double lumen catheter' which is far commoner. The methods section should 
make clear that the  study is retrospective, rather than appearing to be prospective or written in 
the format of what one might expect to be prospective.  
 
 
 
 
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 t he 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.  
 
Yes 
 
 
Are you able to ass ess 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 further  
assessment in your comments to the editors.  
 
I am able to assess th e 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 t he 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  
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 o f 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.  
 
No competing interests  
 
I agree to th e 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 under 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: Double -catheter lavage combined with percutaneous flexible endoscopic debridement for  
infected pancreatic necrosis failed to percutaneous catheter dr ainage  
 
Version: 0 Date: 12 Jun 2017  
 
Reviewer: Robert Sutton  
 
Reviewer's report:  
 
This study provides retrospective data comparing the outcomes of patients with pancreatic 
necrosis managed either by perc utaneous minimally invasive or open necrosectomy. The data 
suggest improved outcomes over that obtained with open necrosectomy by insertion of a drain 
then one week later by opening the track to pass a 'double catheter' for irrigation lavage, followed 
by p ercutaneous flexible endoscopic debridement. The use of the 'double catheter' is a slight 
modification of previously reported methods that might be interpreted as a delaying tactic 
allowing some local resolution prior to formal debridement. The use of a fl exible endoscope is 
well described for per -oral endoscopic debridement of pancreatic necrosis through stents inserted 
via the stomach into the necrosis, but not well described as used here. Although the series is 
small, there is merit in replication of the  finding that minimal access approaches confer 
advantages over the open approach. The 'double catheter' should be properly described as it will 
be confused with a 'double lumen catheter' which is far commoner. The methods section should 
make clear that the  study is retrospective, rather than appearing to be prospective or written in 
the format of what one might expect to be prospective.  
 
 
 
 
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 t he 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.  
 
Yes 
 
 
Are you able to ass ess 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 further  
assessment in your comments to the editors.  
 
I am able to assess th e 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 t he 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  
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 o f 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.  
 
No competing interests  
 
I agree to th e 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 under 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