Reviewer ’s report  
 
Title: What is impact of Nonsteroidal anti -inflammatory drugs  in the prevention of post -
endoscopic retrograde cholangiopancreatography pancreatitis: a meta -analysis o f randomized 
controlled trials  
 
Version: 0 Date: 08 Jan 2018  
 
Reviewer: Árpád Patai  
 
Reviewer's report:  
 
Lyu et al. examined the preventive effect of NSAIDs in post -ERCP pancreatitis (PEP) in a meta -
analysis. The manuscript is interesting, however, it needs some changes before it can be accepted 
for publication.  
 
Major comments:  
1. The inclusion of the study by Luo et al in the meta -analysis is highly debateable, as it was not 
a placebo -controlled trial, but a universal strategy (all patients received indomethacin) was 
compared to a risk -stratified approach. This work should be om itted from the meta -analysis, 
and calculations should be re -done accordingly.  
 
2. Recently, a similar meta -analysis on the effect of indomethacin and diclofenac in the 
prevention of PEP was published in Gastrointestinal Endoscopy (Patai et al. GIE 2017) w ith 
partially different results. What might be the reasons for this? Please discuss this paper, as 
well.  
 
3. Based on their results, the authors suggest that only pre -ERCP diclofenac is effective in the 
prevention of PEP (as opposed to indomethacin). What might be the reasons for this? Should 
it mean different recommendation for the two drugs?  
 
4. The authors state (line 232 -234):  
"Some scholars have suggested that, although there is a certain similarity in the chemical 
structure, indomethacin is the most p otent among all NSAIDs in inhibiting the degree of 
inflammatory response."  
What references support this observation?  
 
 
Minor comments:  
1. The text should be checked for grammar, typos and punctuation, e.g.:  
line 81 spaces  
line 100 If necessary, contact...  
line 116 ..  
line 207 indomethacin  
line 227 the study less  
line 291 Although  
etc 
 
2. There is a repetition at page 10, line 145 -147 (first at page 7, lines 104 -106).  
Are the methods appropriate and well described?  
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.  
 
 
Unable to assess  
 
Are the conclusions drawn 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.  
 
Not relevant to this manuscript  
 
  
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections 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  
organisation 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 manuscript, 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 patents 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 competing 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 journa l. 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 Access 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: What is impact of Nonsteroidal anti -inflammatory drugs  in the prevention of post -
endoscopic retrograde cholangiopancreatography pancreatitis: a meta -analysis o f randomized 
controlled trials  
 
Version: 0 Date: 08 Jan 2018  
 
Reviewer: Árpád Patai  
 
Reviewer's report:  
 
Lyu et al. examined the preventive effect of NSAIDs in post -ERCP pancreatitis (PEP) in a meta -
analysis. The manuscript is interesting, however, it needs some changes before it can be accepted 
for publication.  
 
Major comments:  
1. The inclusion of the study by Luo et al in the meta -analysis is highly debateable, as it was not 
a placebo -controlled trial, but a universal strategy (all patients received indomethacin) was 
compared to a risk -stratified approach. This work should be om itted from the meta -analysis, 
and calculations should be re -done accordingly.  
 
2. Recently, a similar meta -analysis on the effect of indomethacin and diclofenac in the 
prevention of PEP was published in Gastrointestinal Endoscopy (Patai et al. GIE 2017) w ith 
partially different results. What might be the reasons for this? Please discuss this paper, as 
well.  
 
3. Based on their results, the authors suggest that only pre -ERCP diclofenac is effective in the 
prevention of PEP (as opposed to indomethacin). What might be the reasons for this? Should 
it mean different recommendation for the two drugs?  
 
4. The authors state (line 232 -234):  
"Some scholars have suggested that, although there is a certain similarity in the chemical 
structure, indomethacin is the most p otent among all NSAIDs in inhibiting the degree of 
inflammatory response."  
What references support this observation?  
 
 
Minor comments:  
1. The text should be checked for grammar, typos and punctuation, e.g.:  
line 81 spaces  
line 100 If necessary, contact...  
line 116 ..  
line 207 indomethacin  
line 227 the study less  
line 291 Although  
etc 
 
2. There is a repetition at page 10, line 145 -147 (first at page 7, lines 104 -106).  
Are the methods appropriate and well described?  
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.  
 
 
Unable to assess  
 
Are the conclusions drawn 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.  
 
Not relevant to this manuscript  
 
  
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections 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  
organisation 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 manuscript, 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 patents 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 competing 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 journa l. 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 Access 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: What is impact of Nonsteroidal anti -inflammatory drugs  in the prevention of post -
endoscopic retrograde cholangiopancreatography pancreatitis: a meta -analysis o f randomized 
controlled trials  
 
Version: 0 Date: 08 Jan 2018  
 
Reviewer: Árpád Patai  
 
Reviewer's report:  
 
Lyu et al. examined the preventive effect of NSAIDs in post -ERCP pancreatitis (PEP) in a meta -
analysis. The manuscript is interesting, however, it needs some changes before it can be accepted 
for publication.  
 
Major comments:  
1. The inclusion of the study by Luo et al in the meta -analysis is highly debateable, as it was not 
a placebo -controlled trial, but a universal strategy (all patients received indomethacin) was 
compared to a risk -stratified approach. This work should be om itted from the meta -analysis, 
and calculations should be re -done accordingly.  
 
2. Recently, a similar meta -analysis on the effect of indomethacin and diclofenac in the 
prevention of PEP was published in Gastrointestinal Endoscopy (Patai et al. GIE 2017) w ith 
partially different results. What might be the reasons for this? Please discuss this paper, as 
well.  
 
3. Based on their results, the authors suggest that only pre -ERCP diclofenac is effective in the 
prevention of PEP (as opposed to indomethacin). What might be the reasons for this? Should 
it mean different recommendation for the two drugs?  
 
4. The authors state (line 232 -234):  
"Some scholars have suggested that, although there is a certain similarity in the chemical 
structure, indomethacin is the most p otent among all NSAIDs in inhibiting the degree of 
inflammatory response."  
What references support this observation?  
 
 
Minor comments:  
1. The text should be checked for grammar, typos and punctuation, e.g.:  
line 81 spaces  
line 100 If necessary, contact...  
line 116 ..  
line 207 indomethacin  
line 227 the study less  
line 291 Although  
etc 
 
2. There is a repetition at page 10, line 145 -147 (first at page 7, lines 104 -106).  
Are the methods appropriate and well described?  
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.  
 
 
Unable to assess  
 
Are the conclusions drawn 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.  
 
Not relevant to this manuscript  
 
  
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections 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  
organisation 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 manuscript, 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 patents 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 competing 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 journa l. 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 Access 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