Title: Biliary obstruction and pancreatitis after duodenal stent placement in the descending
duodenum: a retrospective study
Version: 2 Date: 11 Apr 2022
Reviewer:  Wenjian Mao
Reviewer's report:
This manuscript reports the results of a retrospective study to identify some risk factors for acute
cholangitis and/or pancreatitis after duodenal stent placement in the descending duodenum and
found that female sex, absence of biliary stents, and tumor invasion to the major duodenal papilla
are the primary risk factors.
The authors are to be complimented on what appears to be a well-designed study of an important
question.  These findings can allow endoscopists to better identify patients at significant risk
and potentially affect clinical decision-making, but still need further validation.
I list my major concerns as below:
Firstly, the definition of acute pancreatitis is not entirely appropriate in the method section.
The diagnosis of acute pancreatitis is defined as meeting at least two of the three following
criteria: (1) abdominal pain consistent with acute pancreatitis; (2) serum lipase (or amylase)
activity greater than three times the upper limit of normal; (3) characteristic findings of acute
pancreatitis on contrast-enhanced computed tomography (CECT) or less commonly magnetic
resonance imaging (MRI) or transabdominal ultrasonography according to the revision of the
Atlanta classification (RAC) criteria.
Secondly, what's the reason for dividing age into > 69 and #69.
Thirdly, as reported by the authors, it is a single center retrospective study including a low
number of patients and thus the individual risk for cholangitis and pancreatitis could not be
evaluated. The results of this study need to be carefully interpreted and further explored.
Title: Biliary obstruction and pancreatitis after duodenal stent placement in the descending
duodenum: a retrospective study
Version: 2 Date: 11 Apr 2022
Reviewer:  Wenjian Mao
Reviewer's report:
This manuscript reports the results of a retrospective study to identify some risk factors for acute
cholangitis and/or pancreatitis after duodenal stent placement in the descending duodenum and
found that female sex, absence of biliary stents, and tumor invasion to the major duodenal papilla
are the primary risk factors.
The authors are to be complimented on what appears to be a well-designed study of an important
question.  These findings can allow endoscopists to better identify patients at significant risk
and potentially affect clinical decision-making, but still need further validation.
I list my major concerns as below:
Firstly, the definition of acute pancreatitis is not entirely appropriate in the method section.
The diagnosis of acute pancreatitis is defined as meeting at least two of the three following
criteria: (1) abdominal pain consistent with acute pancreatitis; (2) serum lipase (or amylase)
activity greater than three times the upper limit of normal; (3) characteristic findings of acute
pancreatitis on contrast-enhanced computed tomography (CECT) or less commonly magnetic
resonance imaging (MRI) or transabdominal ultrasonography according to the revision of the
Atlanta classification (RAC) criteria.
Secondly, what's the reason for dividing age into > 69 and #69.
Thirdly, as reported by the authors, it is a single center retrospective study including a low
number of patients and thus the individual risk for cholangitis and pancreatitis could not be
evaluated. The results of this study need to be carefully interpreted and further explored.
Please review this paper.
user
Title: Biliary obstruction and pancreatitis after duodenal stent placement in the descending
duodenum: a retrospective study
Version: 2 Date: 11 Apr 2022
Reviewer:  Wenjian Mao
Reviewer's report:
This manuscript reports the results of a retrospective study to identify some risk factors for acute
cholangitis and/or pancreatitis after duodenal stent placement in the descending duodenum and
found that female sex, absence of biliary stents, and tumor invasion to the major duodenal papilla
are the primary risk factors.
The authors are to be complimented on what appears to be a well-designed study of an important
question.  These findings can allow endoscopists to better identify patients at significant risk
and potentially affect clinical decision-making, but still need further validation.
I list my major concerns as below:
Firstly, the definition of acute pancreatitis is not entirely appropriate in the method section.
The diagnosis of acute pancreatitis is defined as meeting at least two of the three following
criteria: (1) abdominal pain consistent with acute pancreatitis; (2) serum lipase (or amylase)
activity greater than three times the upper limit of normal; (3) characteristic findings of acute
pancreatitis on contrast-enhanced computed tomography (CECT) or less commonly magnetic
resonance imaging (MRI) or transabdominal ultrasonography according to the revision of the
Atlanta classification (RAC) criteria.
Secondly, what's the reason for dividing age into > 69 and #69.
Thirdly, as reported by the authors, it is a single center retrospective study including a low
number of patients and thus the individual risk for cholangitis and pancreatitis could not be
evaluated. The results of this study need to be carefully interpreted and further explored.
assistant