Title: The use of fully covered self-expandable metal stents in the endoscopic treatment of portal
cavernoma cholangiopathy An Original Article
Version: 1 Date: 13 Aug 2023
Reviewer:  Toshio Tsuyuguchi
Reviewer's report:
#1. What is the reason for the very high incidence of cholecystitis after stenting compared to
malignant lower biliary stricture? Could it be due to compression of the gallbladder cystic duct
or bifurcation of the cystic duct by the portal vein?
#2. Why is the male-to-female ratio significantly skewed toward males? Are there differences
in the causes of PCC (portal cavernoma cholangiopathy)  in the region concerned?
#3. According to the flow chart in figure 1, 10 cases treated with plastic stenting were excluded.
However, 3 cases with a history of plastic stent implantation were also included in the 12 cases
analyzed.
#4. PCC  requires imaging of bile duct compression by the portal vein. Are contrast-enhanced
CT and ultrasound Doppler studies performed in all cases?
#5. It is easier to understand if authors summarize in a table the reports of previous studies in
which CMS was performed for PCC. It would be good to add to that table the studies in which
plastic stents were placed or FCSEMS was placed for hemorrhage.
#6. Why are there fewer relapses and better prognosis after 12 weeks of FCSEMS implantation?
It is unclear why bile duct stenosis does not recur in the long term, since the portal vein should
continue to drain.
Title: The use of fully covered self-expandable metal stents in the endoscopic treatment of portal
cavernoma cholangiopathy An Original Article
Version: 1 Date: 13 Aug 2023
Reviewer:  Toshio Tsuyuguchi
Reviewer's report:
#1. What is the reason for the very high incidence of cholecystitis after stenting compared to
malignant lower biliary stricture? Could it be due to compression of the gallbladder cystic duct
or bifurcation of the cystic duct by the portal vein?
#2. Why is the male-to-female ratio significantly skewed toward males? Are there differences
in the causes of PCC (portal cavernoma cholangiopathy)  in the region concerned?
#3. According to the flow chart in figure 1, 10 cases treated with plastic stenting were excluded.
However, 3 cases with a history of plastic stent implantation were also included in the 12 cases
analyzed.
#4. PCC  requires imaging of bile duct compression by the portal vein. Are contrast-enhanced
CT and ultrasound Doppler studies performed in all cases?
#5. It is easier to understand if authors summarize in a table the reports of previous studies in
which CMS was performed for PCC. It would be good to add to that table the studies in which
plastic stents were placed or FCSEMS was placed for hemorrhage.
#6. Why are there fewer relapses and better prognosis after 12 weeks of FCSEMS implantation?
It is unclear why bile duct stenosis does not recur in the long term, since the portal vein should
continue to drain.
Please review this paper.
user
Title: The use of fully covered self-expandable metal stents in the endoscopic treatment of portal
cavernoma cholangiopathy An Original Article
Version: 1 Date: 13 Aug 2023
Reviewer:  Toshio Tsuyuguchi
Reviewer's report:
#1. What is the reason for the very high incidence of cholecystitis after stenting compared to
malignant lower biliary stricture? Could it be due to compression of the gallbladder cystic duct
or bifurcation of the cystic duct by the portal vein?
#2. Why is the male-to-female ratio significantly skewed toward males? Are there differences
in the causes of PCC (portal cavernoma cholangiopathy)  in the region concerned?
#3. According to the flow chart in figure 1, 10 cases treated with plastic stenting were excluded.
However, 3 cases with a history of plastic stent implantation were also included in the 12 cases
analyzed.
#4. PCC  requires imaging of bile duct compression by the portal vein. Are contrast-enhanced
CT and ultrasound Doppler studies performed in all cases?
#5. It is easier to understand if authors summarize in a table the reports of previous studies in
which CMS was performed for PCC. It would be good to add to that table the studies in which
plastic stents were placed or FCSEMS was placed for hemorrhage.
#6. Why are there fewer relapses and better prognosis after 12 weeks of FCSEMS implantation?
It is unclear why bile duct stenosis does not recur in the long term, since the portal vein should
continue to drain.
assistant