Title: Comparison of the efficacy and safety between palliative biliary stent placement and duct
clearance among elderly patients with choledocholithiasis: A propensity score-matched analysis
Version: 1 Date: 31 Aug 2021
Reviewer's report:
The authors conducted a study to evaluate the usefulness of palliative endoscopic biliary stenting
in elderly patients with choledocholithiasis. The results showed that the median cholangitis-
free period was significantly shorter in the endoscopic biliary stenting group than in the
complete stone removal group; therefore, the authors concluded that palliative endoscopic
biliary stenting should be indicated only for patients with choledocholithiasis who have a poor
prognosis. This is an interesting and well-presented work. Readers will certainly benefit from
the study findings, which provide useful information on strategy development for frail elderly
patients with choledocholithiasis. However, I have few comments and questions regarding the
manuscript.
1. Although the results showed that there were no significant between-group differences
regarding any outcomes, except for cholangitis, the authors have not mentioned procedure time.
Notably, procedure time for biliary stenting is shorter than that for stone removal; therefore,
biliary stenting alone generally helps reduce adverse events in frail elderly patients with poor
general condition.
2. According to the results, cholangitis was mainly caused by stent migration in the endoscopic
biliary stenting group. In this group, straight plastic stents and pigtail stents were used in 68.0%
and 32.0% patients, respectively. Straight stents usually migrate in patients without biliary
stricture. Would it be possible to improve the outcomes in the biliary stenting group by using
pigtail stents in all patients? The authors should provide their opinion on this.
Title: Comparison of the efficacy and safety between palliative biliary stent placement and duct
clearance among elderly patients with choledocholithiasis: A propensity score-matched analysis
Version: 1 Date: 31 Aug 2021
Reviewer's report:
The authors conducted a study to evaluate the usefulness of palliative endoscopic biliary stenting
in elderly patients with choledocholithiasis. The results showed that the median cholangitis-
free period was significantly shorter in the endoscopic biliary stenting group than in the
complete stone removal group; therefore, the authors concluded that palliative endoscopic
biliary stenting should be indicated only for patients with choledocholithiasis who have a poor
prognosis. This is an interesting and well-presented work. Readers will certainly benefit from
the study findings, which provide useful information on strategy development for frail elderly
patients with choledocholithiasis. However, I have few comments and questions regarding the
manuscript.
1. Although the results showed that there were no significant between-group differences
regarding any outcomes, except for cholangitis, the authors have not mentioned procedure time.
Notably, procedure time for biliary stenting is shorter than that for stone removal; therefore,
biliary stenting alone generally helps reduce adverse events in frail elderly patients with poor
general condition.
2. According to the results, cholangitis was mainly caused by stent migration in the endoscopic
biliary stenting group. In this group, straight plastic stents and pigtail stents were used in 68.0%
and 32.0% patients, respectively. Straight stents usually migrate in patients without biliary
stricture. Would it be possible to improve the outcomes in the biliary stenting group by using
pigtail stents in all patients? The authors should provide their opinion on this.
Please review this paper.
user
Title: Comparison of the efficacy and safety between palliative biliary stent placement and duct
clearance among elderly patients with choledocholithiasis: A propensity score-matched analysis
Version: 1 Date: 31 Aug 2021
Reviewer's report:
The authors conducted a study to evaluate the usefulness of palliative endoscopic biliary stenting
in elderly patients with choledocholithiasis. The results showed that the median cholangitis-
free period was significantly shorter in the endoscopic biliary stenting group than in the
complete stone removal group; therefore, the authors concluded that palliative endoscopic
biliary stenting should be indicated only for patients with choledocholithiasis who have a poor
prognosis. This is an interesting and well-presented work. Readers will certainly benefit from
the study findings, which provide useful information on strategy development for frail elderly
patients with choledocholithiasis. However, I have few comments and questions regarding the
manuscript.
1. Although the results showed that there were no significant between-group differences
regarding any outcomes, except for cholangitis, the authors have not mentioned procedure time.
Notably, procedure time for biliary stenting is shorter than that for stone removal; therefore,
biliary stenting alone generally helps reduce adverse events in frail elderly patients with poor
general condition.
2. According to the results, cholangitis was mainly caused by stent migration in the endoscopic
biliary stenting group. In this group, straight plastic stents and pigtail stents were used in 68.0%
and 32.0% patients, respectively. Straight stents usually migrate in patients without biliary
stricture. Would it be possible to improve the outcomes in the biliary stenting group by using
pigtail stents in all patients? The authors should provide their opinion on this.
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