Title: Fully covered self-expandable metal stent for intraprocedural or late-diagnosed Type-II
endoscopic retrograde cholangiopancreatography-related perforations
Version: 0 Date: 26 Jun 2022
Reviewer's report:
Bozbiyik et al. describes that Fully-covered self-expandable metal stent placement (FCSEMS)
for the type-II perforation at endoscopic retrograde cholangiopancreatography (ERCP) is safe
and effective regardless of timeline the perforation is found. They searched a large number
of ERCP cases and finally found 28 cases of type II perforation, which is small sample size.
Although the study is described important experiences, there are several concerns to confirm.
Major Revision:
1. Some endoscopists tend to place nasobiliary drainage tube without metallic stent, or even
after metallic stent placement for safe. How many patients were placed the nasobiliary tube?
Are there any difference of results between patients with and without nasobiliary tube? Please
describe it with additional rows in the table.
2. Additionally, if you place nasobiliary tube in some cases, please correct Methods as well to
describe indications.
3. In page 7, what is “septic-finding on CT”? Please describe with references.
4. In table 1, what is the definition of abnormal papilla anatomy?
5. In table 2, leukocytes and CRPs are analyzed by the highest values in the first 48 hours while
Figure 1 and Figure 2 depicts the first 7 days. I think the values in the tables should be in the
highest values in first 7 days. Please correct the table values to make them consistence.
6. In page 2, “Surgery is frequently used to treat Type-I perforations, whereas conservative
treatment is almost always successful in treating Type-III and Type-IV perforations.” should be
mentioned with references.
7. Most importantly, the authors mentions FCSEMS placement is safe even after the procedure.
However, there should be a golden time. Indeed, they decided to perform consecutive ERCP
within 7 to 48 hours. Therefore, it might be dangerous to perform the next ERCP after 48 hours
of the first ERCP because of severe infection or serious physical conditions. What do you think?
If so, please state a caveat that we should not wait too long until the next ERCP to close type II
perforation and mention rationale golden time with references.
Minor Revision:
1. In the Results of Abstract in Page 2, “whereas in te patients” can be corrected to “whereas
in ten patients”?
2. In table 1, the term "ERCP indication-stone" should be corrected to an appropriate form of
the term.
3. In page 7, the sentence “Oral intake was discontinued, IV hydration was started, antibiotherapy
was initiated, proton-pump inhibitor was initiated, monitorization was performed, full blood
count/biochemistry parameters were monitored, …” should be more concise. For example,
“antibiotherapy, proton-pump inhibitor, and monitorization of vital signs were initiated …”.
Title: Fully covered self-expandable metal stent for intraprocedural or late-diagnosed Type-II
endoscopic retrograde cholangiopancreatography-related perforations
Version: 0 Date: 26 Jun 2022
Reviewer's report:
Bozbiyik et al. describes that Fully-covered self-expandable metal stent placement (FCSEMS)
for the type-II perforation at endoscopic retrograde cholangiopancreatography (ERCP) is safe
and effective regardless of timeline the perforation is found. They searched a large number
of ERCP cases and finally found 28 cases of type II perforation, which is small sample size.
Although the study is described important experiences, there are several concerns to confirm.
Major Revision:
1. Some endoscopists tend to place nasobiliary drainage tube without metallic stent, or even
after metallic stent placement for safe. How many patients were placed the nasobiliary tube?
Are there any difference of results between patients with and without nasobiliary tube? Please
describe it with additional rows in the table.
2. Additionally, if you place nasobiliary tube in some cases, please correct Methods as well to
describe indications.
3. In page 7, what is “septic-finding on CT”? Please describe with references.
4. In table 1, what is the definition of abnormal papilla anatomy?
5. In table 2, leukocytes and CRPs are analyzed by the highest values in the first 48 hours while
Figure 1 and Figure 2 depicts the first 7 days. I think the values in the tables should be in the
highest values in first 7 days. Please correct the table values to make them consistence.
6. In page 2, “Surgery is frequently used to treat Type-I perforations, whereas conservative
treatment is almost always successful in treating Type-III and Type-IV perforations.” should be
mentioned with references.
7. Most importantly, the authors mentions FCSEMS placement is safe even after the procedure.
However, there should be a golden time. Indeed, they decided to perform consecutive ERCP
within 7 to 48 hours. Therefore, it might be dangerous to perform the next ERCP after 48 hours
of the first ERCP because of severe infection or serious physical conditions. What do you think?
If so, please state a caveat that we should not wait too long until the next ERCP to close type II
perforation and mention rationale golden time with references.
Minor Revision:
1. In the Results of Abstract in Page 2, “whereas in te patients” can be corrected to “whereas
in ten patients”?
2. In table 1, the term "ERCP indication-stone" should be corrected to an appropriate form of
the term.
3. In page 7, the sentence “Oral intake was discontinued, IV hydration was started, antibiotherapy
was initiated, proton-pump inhibitor was initiated, monitorization was performed, full blood
count/biochemistry parameters were monitored, …” should be more concise. For example,
“antibiotherapy, proton-pump inhibitor, and monitorization of vital signs were initiated …”.
Please review this paper.
user
Title: Fully covered self-expandable metal stent for intraprocedural or late-diagnosed Type-II
endoscopic retrograde cholangiopancreatography-related perforations
Version: 0 Date: 26 Jun 2022
Reviewer's report:
Bozbiyik et al. describes that Fully-covered self-expandable metal stent placement (FCSEMS)
for the type-II perforation at endoscopic retrograde cholangiopancreatography (ERCP) is safe
and effective regardless of timeline the perforation is found. They searched a large number
of ERCP cases and finally found 28 cases of type II perforation, which is small sample size.
Although the study is described important experiences, there are several concerns to confirm.
Major Revision:
1. Some endoscopists tend to place nasobiliary drainage tube without metallic stent, or even
after metallic stent placement for safe. How many patients were placed the nasobiliary tube?
Are there any difference of results between patients with and without nasobiliary tube? Please
describe it with additional rows in the table.
2. Additionally, if you place nasobiliary tube in some cases, please correct Methods as well to
describe indications.
3. In page 7, what is “septic-finding on CT”? Please describe with references.
4. In table 1, what is the definition of abnormal papilla anatomy?
5. In table 2, leukocytes and CRPs are analyzed by the highest values in the first 48 hours while
Figure 1 and Figure 2 depicts the first 7 days. I think the values in the tables should be in the
highest values in first 7 days. Please correct the table values to make them consistence.
6. In page 2, “Surgery is frequently used to treat Type-I perforations, whereas conservative
treatment is almost always successful in treating Type-III and Type-IV perforations.” should be
mentioned with references.
7. Most importantly, the authors mentions FCSEMS placement is safe even after the procedure.
However, there should be a golden time. Indeed, they decided to perform consecutive ERCP
within 7 to 48 hours. Therefore, it might be dangerous to perform the next ERCP after 48 hours
of the first ERCP because of severe infection or serious physical conditions. What do you think?
If so, please state a caveat that we should not wait too long until the next ERCP to close type II
perforation and mention rationale golden time with references.
Minor Revision:
1. In the Results of Abstract in Page 2, “whereas in te patients” can be corrected to “whereas
in ten patients”?
2. In table 1, the term "ERCP indication-stone" should be corrected to an appropriate form of
the term.
3. In page 7, the sentence “Oral intake was discontinued, IV hydration was started, antibiotherapy
was initiated, proton-pump inhibitor was initiated, monitorization was performed, full blood
count/biochemistry parameters were monitored, …” should be more concise. For example,
“antibiotherapy, proton-pump inhibitor, and monitorization of vital signs were initiated …”.
assistant