Revie wer’s report  
 
Title: Dexmedetomidine is safe and reduces the additional  dose of midazolam for sedation 
during Endoscopic retrograde cholangiopancreatography in very elderly patients  
 
Version: 0 Date: 19 May 2018  
 
Reviewer: Akira Imoto  
 
Reviewer's report:  
 
Major  
 
1. It is an article on the usefulness of combined administration of DEX and midazolam 
during ERCP for very elderly patients. It is stated that there are not sufficiently effective 
reports by DEX alone. What type of sedation do you c onsider suitable for the elderly in 
the future? Please describe the future prospects based on the fact that the blood pressure 
declines or the pulse drops this time.  
 
 
2. DEX's weak point is that it takes time before ERCP. What do you think about the 
increas e in time of the whole ERCP and the extra need for a place before ERCP?  
 
 
3. Is there any report on the combined use of midazolam and PRF during ERCP? If there is 
one, please discuss how it is compared with this DEX combination.  
 
Minor  
 
1. Please describe the definition of the procedure time.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the 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 assess any statistics in the manuscript or would you re commend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indic ate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
Declaration 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 fro m an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat 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' below.  
 
I agree to the open peer review policy of the journal. I understan d that my na me will be included 
on my repo rt to the authors and, if the manuscript is accepted f or 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 a n Open Access Creati ve 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 in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to th e open peer review policy of the journal  
 
Revie wer’s report  
 
Title: Dexmedetomidine is safe and reduces the additional  dose of midazolam for sedation 
during Endoscopic retrograde cholangiopancreatography in very elderly patients  
 
Version: 0 Date: 19 May 2018  
 
Reviewer: Akira Imoto  
 
Reviewer's report:  
 
Major  
 
1. It is an article on the usefulness of combined administration of DEX and midazolam 
during ERCP for very elderly patients. It is stated that there are not sufficiently effective 
reports by DEX alone. What type of sedation do you c onsider suitable for the elderly in 
the future? Please describe the future prospects based on the fact that the blood pressure 
declines or the pulse drops this time.  
 
 
2. DEX's weak point is that it takes time before ERCP. What do you think about the 
increas e in time of the whole ERCP and the extra need for a place before ERCP?  
 
 
3. Is there any report on the combined use of midazolam and PRF during ERCP? If there is 
one, please discuss how it is compared with this DEX combination.  
 
Minor  
 
1. Please describe the definition of the procedure time.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the 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 assess any statistics in the manuscript or would you re commend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indic ate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
Declaration 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 fro m an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat 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' below.  
 
I agree to the open peer review policy of the journal. I understan d that my na me will be included 
on my repo rt to the authors and, if the manuscript is accepted f or 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 a n Open Access Creati ve 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 in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to th e open peer review policy of the journal  
 
Please review this paper.
user
Revie wer’s report  
 
Title: Dexmedetomidine is safe and reduces the additional  dose of midazolam for sedation 
during Endoscopic retrograde cholangiopancreatography in very elderly patients  
 
Version: 0 Date: 19 May 2018  
 
Reviewer: Akira Imoto  
 
Reviewer's report:  
 
Major  
 
1. It is an article on the usefulness of combined administration of DEX and midazolam 
during ERCP for very elderly patients. It is stated that there are not sufficiently effective 
reports by DEX alone. What type of sedation do you c onsider suitable for the elderly in 
the future? Please describe the future prospects based on the fact that the blood pressure 
declines or the pulse drops this time.  
 
 
2. DEX's weak point is that it takes time before ERCP. What do you think about the 
increas e in time of the whole ERCP and the extra need for a place before ERCP?  
 
 
3. Is there any report on the combined use of midazolam and PRF during ERCP? If there is 
one, please discuss how it is compared with this DEX combination.  
 
Minor  
 
1. Please describe the definition of the procedure time.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the 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 assess any statistics in the manuscript or would you re commend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indic ate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
Declaration 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 fro m an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat 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' below.  
 
I agree to the open peer review policy of the journal. I understan d that my na me will be included 
on my repo rt to the authors and, if the manuscript is accepted f or 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 a n Open Access Creati ve 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 in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to th e open peer review policy of the journal  
 
assistant