Reviewer's report
Title:Refractory Obstructive Jaundice in a Child Affected by
Thalassodrepanocytosis: A New Endoscopic Approach
Version: 1Date:3 July 2010
Reviewer: HIDEYUKI YOSHITOMI
Reviewer's report:
BMC Gastroenterology
Case report
Refractory obstructive jaundice in a child affected by thalassodrepancytosis: A
new endoscopic approach
This manuscript describes a rare case of severe and persistent obstructive
jaundice in a child with thalassodrepanocytosis and Gilbert’s syndrome. The
authors successfully treated the patients with deep biliary washing and stenting
using new covered stent.
This manuscript showed an interesting case and might be useful information for
readers who will treat resemble cases. However I think there are several points
which authors should respond for publication in BMC gastroenterology.
Major compulsory revisions
1) The authors should describe the long time prognosis of the patient. They only
describe that the patient was extracted the biliary stent 2 months later (page3
line5). How was the prognosis after removal of the stent? Did the patient never
repeat the sever icterus and/or choledocholithiasis observed after that? As ERCP
showed that slightly bending of common bile duct on Bi and stenosis on Bs
(figure4), I wonder if the stent should be placed at least few more months. Also
they should discuss the timing of the biliary stent removal of the patients who
have dense bile juice in the discussion. In addition, it is better to describe the
advantage of this PTFE covered metallic stent against normal plastic stent. It
might not be needed to use the PTFE covered stent if the stent is placed only for
2 months.
2) The authors should describe the details of the first operation
(cholecystectomy) (page2 line 9-10). How was the inflammation status around
the gallbladder? Was the severe icterus observed before the first operation? As
seen in figure 1, there are several surgical clips just beside the bile duct and the
joint point of cystic duct to CBD seems to have stenosis and bending. I want to
confirm the stenosis of the CBD is related to the disease itself, not to the
operation.
Minor essential revisions
1) Please indicate the location of angle (page2 line 22) in Figure 1.
2) In Figure 2, please put the picture without the endoscope so that the stent can
be seen more clearly
3) The resolution of Figure 3 is not enough. Does this picture show the duodenal
view?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Refractory Obstructive Jaundice in a Child Affected by
Thalassodrepanocytosis: A New Endoscopic Approach
Version: 1Date:3 July 2010
Reviewer: HIDEYUKI YOSHITOMI
Reviewer's report:
BMC Gastroenterology
Case report
Refractory obstructive jaundice in a child affected by thalassodrepancytosis: A
new endoscopic approach
This manuscript describes a rare case of severe and persistent obstructive
jaundice in a child with thalassodrepanocytosis and Gilbert’s syndrome. The
authors successfully treated the patients with deep biliary washing and stenting
using new covered stent.
This manuscript showed an interesting case and might be useful information for
readers who will treat resemble cases. However I think there are several points
which authors should respond for publication in BMC gastroenterology.
Major compulsory revisions
1) The authors should describe the long time prognosis of the patient. They only
describe that the patient was extracted the biliary stent 2 months later (page3
line5). How was the prognosis after removal of the stent? Did the patient never
repeat the sever icterus and/or choledocholithiasis observed after that? As ERCP
showed that slightly bending of common bile duct on Bi and stenosis on Bs
(figure4), I wonder if the stent should be placed at least few more months. Also
they should discuss the timing of the biliary stent removal of the patients who
have dense bile juice in the discussion. In addition, it is better to describe the
advantage of this PTFE covered metallic stent against normal plastic stent. It
might not be needed to use the PTFE covered stent if the stent is placed only for
2 months.
2) The authors should describe the details of the first operation
(cholecystectomy) (page2 line 9-10). How was the inflammation status around
the gallbladder? Was the severe icterus observed before the first operation? As
seen in figure 1, there are several surgical clips just beside the bile duct and the
joint point of cystic duct to CBD seems to have stenosis and bending. I want to
confirm the stenosis of the CBD is related to the disease itself, not to the
operation.
Minor essential revisions
1) Please indicate the location of angle (page2 line 22) in Figure 1.
2) In Figure 2, please put the picture without the endoscope so that the stent can
be seen more clearly
3) The resolution of Figure 3 is not enough. Does this picture show the duodenal
view?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Refractory Obstructive Jaundice in a Child Affected by
Thalassodrepanocytosis: A New Endoscopic Approach
Version: 1Date:3 July 2010
Reviewer: HIDEYUKI YOSHITOMI
Reviewer's report:
BMC Gastroenterology
Case report
Refractory obstructive jaundice in a child affected by thalassodrepancytosis: A
new endoscopic approach
This manuscript describes a rare case of severe and persistent obstructive
jaundice in a child with thalassodrepanocytosis and Gilbert’s syndrome. The
authors successfully treated the patients with deep biliary washing and stenting
using new covered stent.
This manuscript showed an interesting case and might be useful information for
readers who will treat resemble cases. However I think there are several points
which authors should respond for publication in BMC gastroenterology.
Major compulsory revisions
1) The authors should describe the long time prognosis of the patient. They only
describe that the patient was extracted the biliary stent 2 months later (page3
line5). How was the prognosis after removal of the stent? Did the patient never
repeat the sever icterus and/or choledocholithiasis observed after that? As ERCP
showed that slightly bending of common bile duct on Bi and stenosis on Bs
(figure4), I wonder if the stent should be placed at least few more months. Also
they should discuss the timing of the biliary stent removal of the patients who
have dense bile juice in the discussion. In addition, it is better to describe the
advantage of this PTFE covered metallic stent against normal plastic stent. It
might not be needed to use the PTFE covered stent if the stent is placed only for
2 months.
2) The authors should describe the details of the first operation
(cholecystectomy) (page2 line 9-10). How was the inflammation status around
the gallbladder? Was the severe icterus observed before the first operation? As
seen in figure 1, there are several surgical clips just beside the bile duct and the
joint point of cystic duct to CBD seems to have stenosis and bending. I want to
confirm the stenosis of the CBD is related to the disease itself, not to the
operation.
Minor essential revisions
1) Please indicate the location of angle (page2 line 22) in Figure 1.
2) In Figure 2, please put the picture without the endoscope so that the stent can
be seen more clearly
3) The resolution of Figure 3 is not enough. Does this picture show the duodenal
view?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
assistant