Reviewer's report
Title:Endoscopic stenting for hilar cholangiocarcinoma: Efficacy of unilateral and
bilateral placement of plastic and metal stents in a retrospective review of 480
patients
Version: 1Date:28 April 2012
Reviewer: Itaru Naitoh
Reviewer's report:
Overview
The authors described the outcomes of endoscopic biliary drainage for hilar
cholamgiocarcinoma retrospectively. This study consists of large sample
including two kinds of stent (PS and SEMS) and two kinds of drainage area
(unilateral or bilateral). They concluded that SEMS was significant better
outcomes in respect of technical and clinical success, complication rate and
cumulative stent patency. Furthermore, they concluded that the cumulative stent
patency of bilateral SEMS or PS was significantly better than that of unilateral in
Bismuth II patients. These results are very important points about hilar biliary
drainage that we would like to know. These results are convincing for us because
of large sample size.
Major Compulsory Revisions
1. Unilateral or bilateral drainage was performed in the patients with Bismuth type
2 (Group 2). The authors should indicate the criteria which drainage method was
selected.
2. PS or SEMS was used in this study. The authors should indicate the criteria
which stent was selected. There is a possibility that selection bias might affect
the outcomes.
3. The rates of unilateral and bilateral drainage in Bismuth Type 1 (Group1) and
Type3,4 (Group3) were not mentioned. The authors should describe these rates.
4. The authors should describe the rate of stent-within-stent and side-by-side
methods in bilateral SEMS. There is the possibility that the method affect the
outocomes.
5. The results of this study were all univariate analysis. However, this study
includes many sample size. The authors should indicate multivariate analysis
assessing cumulative stent patency in respect of such as kinds of stent and stent
deployment. Multivariate analysis is more convincing in this study.
6. The authors should indicate the number of re-intervention for stent occlusion
between PS and SEMS. We consider that this result is important for superiority of
SEMS to PS.
7. The discussion section is very long. The authors should describe more
intelligibly and briefly.
8. There are a lot of Figures and Tables. The author should delete the Tables
and Figures which are not important (Table2, Figure9).
9. Table1 and 2 are confusing and difficult to understand. The authors should
revise these tables more intelligibly.
Minor Essential Revisions
Discretionary Revisions
1. In patients and study section, the authors should describe the diagnostic rate
that was confirmed histopathologically.
2. In patients and study section, the authors should describe the rate of
unresectable reason (the rate of medical fitness or disease extent).
Level of interest: An article of importance in its field
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:Endoscopic stenting for hilar cholangiocarcinoma: Efficacy of unilateral and
bilateral placement of plastic and metal stents in a retrospective review of 480
patients
Version: 1Date:28 April 2012
Reviewer: Itaru Naitoh
Reviewer's report:
Overview
The authors described the outcomes of endoscopic biliary drainage for hilar
cholamgiocarcinoma retrospectively. This study consists of large sample
including two kinds of stent (PS and SEMS) and two kinds of drainage area
(unilateral or bilateral). They concluded that SEMS was significant better
outcomes in respect of technical and clinical success, complication rate and
cumulative stent patency. Furthermore, they concluded that the cumulative stent
patency of bilateral SEMS or PS was significantly better than that of unilateral in
Bismuth II patients. These results are very important points about hilar biliary
drainage that we would like to know. These results are convincing for us because
of large sample size.
Major Compulsory Revisions
1. Unilateral or bilateral drainage was performed in the patients with Bismuth type
2 (Group 2). The authors should indicate the criteria which drainage method was
selected.
2. PS or SEMS was used in this study. The authors should indicate the criteria
which stent was selected. There is a possibility that selection bias might affect
the outcomes.
3. The rates of unilateral and bilateral drainage in Bismuth Type 1 (Group1) and
Type3,4 (Group3) were not mentioned. The authors should describe these rates.
4. The authors should describe the rate of stent-within-stent and side-by-side
methods in bilateral SEMS. There is the possibility that the method affect the
outocomes.
5. The results of this study were all univariate analysis. However, this study
includes many sample size. The authors should indicate multivariate analysis
assessing cumulative stent patency in respect of such as kinds of stent and stent
deployment. Multivariate analysis is more convincing in this study.
6. The authors should indicate the number of re-intervention for stent occlusion
between PS and SEMS. We consider that this result is important for superiority of
SEMS to PS.
7. The discussion section is very long. The authors should describe more
intelligibly and briefly.
8. There are a lot of Figures and Tables. The author should delete the Tables
and Figures which are not important (Table2, Figure9).
9. Table1 and 2 are confusing and difficult to understand. The authors should
revise these tables more intelligibly.
Minor Essential Revisions
Discretionary Revisions
1. In patients and study section, the authors should describe the diagnostic rate
that was confirmed histopathologically.
2. In patients and study section, the authors should describe the rate of
unresectable reason (the rate of medical fitness or disease extent).
Level of interest: An article of importance in its field
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:Endoscopic stenting for hilar cholangiocarcinoma: Efficacy of unilateral and
bilateral placement of plastic and metal stents in a retrospective review of 480
patients
Version: 1Date:28 April 2012
Reviewer: Itaru Naitoh
Reviewer's report:
Overview
The authors described the outcomes of endoscopic biliary drainage for hilar
cholamgiocarcinoma retrospectively. This study consists of large sample
including two kinds of stent (PS and SEMS) and two kinds of drainage area
(unilateral or bilateral). They concluded that SEMS was significant better
outcomes in respect of technical and clinical success, complication rate and
cumulative stent patency. Furthermore, they concluded that the cumulative stent
patency of bilateral SEMS or PS was significantly better than that of unilateral in
Bismuth II patients. These results are very important points about hilar biliary
drainage that we would like to know. These results are convincing for us because
of large sample size.
Major Compulsory Revisions
1. Unilateral or bilateral drainage was performed in the patients with Bismuth type
2 (Group 2). The authors should indicate the criteria which drainage method was
selected.
2. PS or SEMS was used in this study. The authors should indicate the criteria
which stent was selected. There is a possibility that selection bias might affect
the outcomes.
3. The rates of unilateral and bilateral drainage in Bismuth Type 1 (Group1) and
Type3,4 (Group3) were not mentioned. The authors should describe these rates.
4. The authors should describe the rate of stent-within-stent and side-by-side
methods in bilateral SEMS. There is the possibility that the method affect the
outocomes.
5. The results of this study were all univariate analysis. However, this study
includes many sample size. The authors should indicate multivariate analysis
assessing cumulative stent patency in respect of such as kinds of stent and stent
deployment. Multivariate analysis is more convincing in this study.
6. The authors should indicate the number of re-intervention for stent occlusion
between PS and SEMS. We consider that this result is important for superiority of
SEMS to PS.
7. The discussion section is very long. The authors should describe more
intelligibly and briefly.
8. There are a lot of Figures and Tables. The author should delete the Tables
and Figures which are not important (Table2, Figure9).
9. Table1 and 2 are confusing and difficult to understand. The authors should
revise these tables more intelligibly.
Minor Essential Revisions
Discretionary Revisions
1. In patients and study section, the authors should describe the diagnostic rate
that was confirmed histopathologically.
2. In patients and study section, the authors should describe the rate of
unresectable reason (the rate of medical fitness or disease extent).
Level of interest: An article of importance in its field
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'
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