Reviewer ’s report  
 
Title: The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon 
dilation for removal of large bile duct stones  
 
Version: 1 Date: 18 Dec 2018  
 
Reviewer: Sang -Heum Park  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than up loading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your c omments to the authors.  
 
[Major comment]  
(1) In the method, the residual stones were removed after 3 to 7 days without repeating EST or 
EPLBD. My guestion is as follows; Did not ML also use it?  
 
(2) Limited EST -EPLBD group resulted in similar outcomes in overall successful stone removal 
(98.3%) compared to EST group  (93.5%) and EPLBD group (92.7%) (p=0.337). Limited 
EST-EPLBD group had higher success rate   of 1st session treatment (98.3%) than EST group 
(83.9%) and EPLBD group (86.5%) (p=0.032).  
The need o f ML was 4 patients (12.9%) in EST group, 10 patients (10.4%) in EPLBD group and 
2 patients (3.4%) in limited EST -EPLBD group.  
 
My question is as follows; Was there no difference among three groups in using ML in the first 
session?  
(3) If there was a diff erence among thress groups in using ML in the first session, why?  
 
(4) Limited EST -EPLBD group had a higher success rate of 1st session treatment compared to 
EST group and EPLBD group (p=0.032). Why did such good result in limited EST -EPLBD 
group?  
Is there any reasons to get such good result in limited EST -EPLBD compared to other two 
groups?  
 
[Minor comment]  
(1) In the method of the abstract, the following contents should be corrected; 258 were 
diagnosed with difficult biliary cannulation.  
 
(2) In the method of the abstract, what is PS?  
 
(3) In the method, there is no mention whether sedatives such as midazolam or propofol 
administered or not. Was not sedatives injected?  
Are the methods appropriate and well des cribed?  
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 dr awn 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 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 recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language correct ions before being published  
 
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 from an  
organisat ion 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 manuscri pt, 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 patent s 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 c ompeting interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the 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 Acc ess 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: The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon 
dilation for removal of large bile duct stones  
 
Version: 1 Date: 18 Dec 2018  
 
Reviewer: Sang -Heum Park  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than up loading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your c omments to the authors.  
 
[Major comment]  
(1) In the method, the residual stones were removed after 3 to 7 days without repeating EST or 
EPLBD. My guestion is as follows; Did not ML also use it?  
 
(2) Limited EST -EPLBD group resulted in similar outcomes in overall successful stone removal 
(98.3%) compared to EST group  (93.5%) and EPLBD group (92.7%) (p=0.337). Limited 
EST-EPLBD group had higher success rate   of 1st session treatment (98.3%) than EST group 
(83.9%) and EPLBD group (86.5%) (p=0.032).  
The need o f ML was 4 patients (12.9%) in EST group, 10 patients (10.4%) in EPLBD group and 
2 patients (3.4%) in limited EST -EPLBD group.  
 
My question is as follows; Was there no difference among three groups in using ML in the first 
session?  
(3) If there was a diff erence among thress groups in using ML in the first session, why?  
 
(4) Limited EST -EPLBD group had a higher success rate of 1st session treatment compared to 
EST group and EPLBD group (p=0.032). Why did such good result in limited EST -EPLBD 
group?  
Is there any reasons to get such good result in limited EST -EPLBD compared to other two 
groups?  
 
[Minor comment]  
(1) In the method of the abstract, the following contents should be corrected; 258 were 
diagnosed with difficult biliary cannulation.  
 
(2) In the method of the abstract, what is PS?  
 
(3) In the method, there is no mention whether sedatives such as midazolam or propofol 
administered or not. Was not sedatives injected?  
Are the methods appropriate and well des cribed?  
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 dr awn 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 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 recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language correct ions before being published  
 
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 from an  
organisat ion 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 manuscri pt, 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 patent s 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 c ompeting interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the 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 Acc ess 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: The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon 
dilation for removal of large bile duct stones  
 
Version: 1 Date: 18 Dec 2018  
 
Reviewer: Sang -Heum Park  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than up loading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your c omments to the authors.  
 
[Major comment]  
(1) In the method, the residual stones were removed after 3 to 7 days without repeating EST or 
EPLBD. My guestion is as follows; Did not ML also use it?  
 
(2) Limited EST -EPLBD group resulted in similar outcomes in overall successful stone removal 
(98.3%) compared to EST group  (93.5%) and EPLBD group (92.7%) (p=0.337). Limited 
EST-EPLBD group had higher success rate   of 1st session treatment (98.3%) than EST group 
(83.9%) and EPLBD group (86.5%) (p=0.032).  
The need o f ML was 4 patients (12.9%) in EST group, 10 patients (10.4%) in EPLBD group and 
2 patients (3.4%) in limited EST -EPLBD group.  
 
My question is as follows; Was there no difference among three groups in using ML in the first 
session?  
(3) If there was a diff erence among thress groups in using ML in the first session, why?  
 
(4) Limited EST -EPLBD group had a higher success rate of 1st session treatment compared to 
EST group and EPLBD group (p=0.032). Why did such good result in limited EST -EPLBD 
group?  
Is there any reasons to get such good result in limited EST -EPLBD compared to other two 
groups?  
 
[Minor comment]  
(1) In the method of the abstract, the following contents should be corrected; 258 were 
diagnosed with difficult biliary cannulation.  
 
(2) In the method of the abstract, what is PS?  
 
(3) In the method, there is no mention whether sedatives such as midazolam or propofol 
administered or not. Was not sedatives injected?  
Are the methods appropriate and well des cribed?  
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 dr awn 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 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 recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language correct ions before being published  
 
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 from an  
organisat ion 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 manuscri pt, 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 patent s 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 c ompeting interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the 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 Acc ess 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