Title: Comparison of Metal Versus Plastic Stent for Preoperative Biliary Drainage in Patients
With Pancreatic Cancer Undergoing Neoadjuvant Therapy: A Meta-Analysis and Systematic
Review
Version: 0 Date: 19 May 2023
Reviewer:  Harishankar Gopakumar
Reviewer's report:
Dear Authors,
It was a pleasure to read your work titled “Comparison of Metal Versus Plastic Stent for
Preoperative Biliary Drainage in Patients With Pancreatic Cancer Undergoing Neoadjuvant
Therapy: A Meta-Analysis and Systematic Review”.
Overall, a good study with clinical implications. My concerns
Major
Authors state that "To the best of our knowledge, this is the first meta-analysis to focus on
this topic". However, there are other prior meta-analysis evaluating the same outcome. Please
see examples below. Can the authors explain how this new meta-analysis is different from the
previous ones on the same topic and what new conclusions can readers draw from this new study.
Kumar, N,  Jena, A,  Sharma, V,  Shukla, S,  Shah, J.  Outcome of metal vs plastic
stents for biliary obstruction in patients with pancreatic carcinoma undergoing neoadjuvant
chemoradiotherapy: A systematic review and meta-analysis. J Hepatobiliary Pancreat Sci.  2023;
30: 419– 428. https://doi.org/10.1002/jhbp.1240
Du J, Gao X, Zhang H, Wan Z, Yu H, Wang D. Stent Selection in Preoperative Biliary
Drainage for Patients With Operable Pancreatic Cancer Receiving Neoadjuvant Therapy: A
Meta-Analysis and Systematic Review. Front Surg. 2022 Jun 30;9:875504. doi: 10.3389/
fsurg.2022.875504. PMID: 35846957; PMCID: PMC9280034.
Minor
- Please expand the abbreviation RBO in the results section as this has not been done before.
- "Fewer complications may be helpful for enough anticancer agent". Please elaborate this
statement and it is not very clear what the authors are to and please provide a reference to validate
this statement.
- Can the authors elaborate on the timing of metal stent placement in that study arm. A plastic
stent is usually placed at the time of initial evaluation (EUS with biopsy/ERCP with biopsies)
for a suspected pancreatic Ca and decision regarding metal stent if often done after pathologic
confirmation of the diagnosis. So in the studies using metal stents, were they placed replacing
a previously placed plastic stent and if so, was that done when there was clinical evidence of
biliary obstruction or as part of the study protocol ?
Title: Comparison of Metal Versus Plastic Stent for Preoperative Biliary Drainage in Patients
With Pancreatic Cancer Undergoing Neoadjuvant Therapy: A Meta-Analysis and Systematic
Review
Version: 0 Date: 19 May 2023
Reviewer:  Harishankar Gopakumar
Reviewer's report:
Dear Authors,
It was a pleasure to read your work titled “Comparison of Metal Versus Plastic Stent for
Preoperative Biliary Drainage in Patients With Pancreatic Cancer Undergoing Neoadjuvant
Therapy: A Meta-Analysis and Systematic Review”.
Overall, a good study with clinical implications. My concerns
Major
Authors state that "To the best of our knowledge, this is the first meta-analysis to focus on
this topic". However, there are other prior meta-analysis evaluating the same outcome. Please
see examples below. Can the authors explain how this new meta-analysis is different from the
previous ones on the same topic and what new conclusions can readers draw from this new study.
Kumar, N,  Jena, A,  Sharma, V,  Shukla, S,  Shah, J.  Outcome of metal vs plastic
stents for biliary obstruction in patients with pancreatic carcinoma undergoing neoadjuvant
chemoradiotherapy: A systematic review and meta-analysis. J Hepatobiliary Pancreat Sci.  2023;
30: 419– 428. https://doi.org/10.1002/jhbp.1240
Du J, Gao X, Zhang H, Wan Z, Yu H, Wang D. Stent Selection in Preoperative Biliary
Drainage for Patients With Operable Pancreatic Cancer Receiving Neoadjuvant Therapy: A
Meta-Analysis and Systematic Review. Front Surg. 2022 Jun 30;9:875504. doi: 10.3389/
fsurg.2022.875504. PMID: 35846957; PMCID: PMC9280034.
Minor
- Please expand the abbreviation RBO in the results section as this has not been done before.
- "Fewer complications may be helpful for enough anticancer agent". Please elaborate this
statement and it is not very clear what the authors are to and please provide a reference to validate
this statement.
- Can the authors elaborate on the timing of metal stent placement in that study arm. A plastic
stent is usually placed at the time of initial evaluation (EUS with biopsy/ERCP with biopsies)
for a suspected pancreatic Ca and decision regarding metal stent if often done after pathologic
confirmation of the diagnosis. So in the studies using metal stents, were they placed replacing
a previously placed plastic stent and if so, was that done when there was clinical evidence of
biliary obstruction or as part of the study protocol ?
Please review this paper.
user
Title: Comparison of Metal Versus Plastic Stent for Preoperative Biliary Drainage in Patients
With Pancreatic Cancer Undergoing Neoadjuvant Therapy: A Meta-Analysis and Systematic
Review
Version: 0 Date: 19 May 2023
Reviewer:  Harishankar Gopakumar
Reviewer's report:
Dear Authors,
It was a pleasure to read your work titled “Comparison of Metal Versus Plastic Stent for
Preoperative Biliary Drainage in Patients With Pancreatic Cancer Undergoing Neoadjuvant
Therapy: A Meta-Analysis and Systematic Review”.
Overall, a good study with clinical implications. My concerns
Major
Authors state that "To the best of our knowledge, this is the first meta-analysis to focus on
this topic". However, there are other prior meta-analysis evaluating the same outcome. Please
see examples below. Can the authors explain how this new meta-analysis is different from the
previous ones on the same topic and what new conclusions can readers draw from this new study.
Kumar, N,  Jena, A,  Sharma, V,  Shukla, S,  Shah, J.  Outcome of metal vs plastic
stents for biliary obstruction in patients with pancreatic carcinoma undergoing neoadjuvant
chemoradiotherapy: A systematic review and meta-analysis. J Hepatobiliary Pancreat Sci.  2023;
30: 419– 428. https://doi.org/10.1002/jhbp.1240
Du J, Gao X, Zhang H, Wan Z, Yu H, Wang D. Stent Selection in Preoperative Biliary
Drainage for Patients With Operable Pancreatic Cancer Receiving Neoadjuvant Therapy: A
Meta-Analysis and Systematic Review. Front Surg. 2022 Jun 30;9:875504. doi: 10.3389/
fsurg.2022.875504. PMID: 35846957; PMCID: PMC9280034.
Minor
- Please expand the abbreviation RBO in the results section as this has not been done before.
- "Fewer complications may be helpful for enough anticancer agent". Please elaborate this
statement and it is not very clear what the authors are to and please provide a reference to validate
this statement.
- Can the authors elaborate on the timing of metal stent placement in that study arm. A plastic
stent is usually placed at the time of initial evaluation (EUS with biopsy/ERCP with biopsies)
for a suspected pancreatic Ca and decision regarding metal stent if often done after pathologic
confirmation of the diagnosis. So in the studies using metal stents, were they placed replacing
a previously placed plastic stent and if so, was that done when there was clinical evidence of
biliary obstruction or as part of the study protocol ?
assistant