Title: Whether preoperative biliary drainage leads to better patient outcomes of
pancreaticoduodenectomy: A meta-analysis and systematic review
Version: 2 Date: 17 Feb 2025
Reviewer's report:
Thank you.
1. This study has not looked into the time interval between the PBD and PD. So the conclusion
regarding the timing of surgery after PBD cannot be made.
2. Please explain the following statement written in discussion. "The most direct cause of
obstructive jaundice is hyperbilirubinemia, which is closely related to biliary hypertension and
chronic consumption of malignant tumors"
3.It is important to look into the type of preoperative biliary drainage. This statement  "the
destruction of the barrier function of the sphincter of Oddi by PBD operation" in discussion will
only be true for endoscopic drainage and not for percutaneous transhepatic drainage.
4.PBD is a procedure not an operation. Please be consistent in mentioning PBD as an invasive
procedure and not an operation.
Title: Whether preoperative biliary drainage leads to better patient outcomes of
pancreaticoduodenectomy: A meta-analysis and systematic review
Version: 2 Date: 17 Feb 2025
Reviewer's report:
Thank you.
1. This study has not looked into the time interval between the PBD and PD. So the conclusion
regarding the timing of surgery after PBD cannot be made.
2. Please explain the following statement written in discussion. "The most direct cause of
obstructive jaundice is hyperbilirubinemia, which is closely related to biliary hypertension and
chronic consumption of malignant tumors"
3.It is important to look into the type of preoperative biliary drainage. This statement  "the
destruction of the barrier function of the sphincter of Oddi by PBD operation" in discussion will
only be true for endoscopic drainage and not for percutaneous transhepatic drainage.
4.PBD is a procedure not an operation. Please be consistent in mentioning PBD as an invasive
procedure and not an operation.
Please review this paper.
user
Title: Whether preoperative biliary drainage leads to better patient outcomes of
pancreaticoduodenectomy: A meta-analysis and systematic review
Version: 2 Date: 17 Feb 2025
Reviewer's report:
Thank you.
1. This study has not looked into the time interval between the PBD and PD. So the conclusion
regarding the timing of surgery after PBD cannot be made.
2. Please explain the following statement written in discussion. "The most direct cause of
obstructive jaundice is hyperbilirubinemia, which is closely related to biliary hypertension and
chronic consumption of malignant tumors"
3.It is important to look into the type of preoperative biliary drainage. This statement  "the
destruction of the barrier function of the sphincter of Oddi by PBD operation" in discussion will
only be true for endoscopic drainage and not for percutaneous transhepatic drainage.
4.PBD is a procedure not an operation. Please be consistent in mentioning PBD as an invasive
procedure and not an operation.
assistant