Reviewer's report 
 Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review Title: 
 1  15 March 2007 Version: Date: 
 alessandro A repici Reviewer: 
Reviewer's report: 
General 
The manuscript from the Rotterdam group is an excellent and systematic review of the two different 
treatment modalities for palliation of gastric outlet obstruction. This manuscript covers an area in continuous 
updating for which there are no extablished guidelines and clinical approaches can vary depending on 
whom is taking care of the patient. So it is worthwhile this careful and objective evaluation of available data 
on literature. I appreciated the excellent analysis of the single outcomes and the objective discussion in 
which the weak points of the endoscopic approach (complication rate as high as surgical treatment, lack of 
long-term efficacy, etc) are correctly ruled out. Despite the fact that just a limited number of true randomized 
studies have been published, this review may allow to draw significant conclusions on what is the most 
appropriate approach for the different stages of disease leading to the gastric outlet obstruction. 
------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
no major revision are needed 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
no minor revision are needed 
------------------------------------------------------------------------------- Discretionary Revisions (which the author can choose to ignore) It could be useful, if possible, to compare the results of patients treated with uncovered versus covered 
stent. May the use of a covered stent afford a more prolonged benefit on luminal patency? This issue has 
been already proven for the esophageal cancer and it would be nice if the authors could mention this possibility in the discussion, even as potential improvement for the future. Moreover it would interesting to 
compare the outcomes of the two different approach basing on the cause of duodenal obstruction. Does the 
obstruction from a pancreatic cancer behaviour differently than an obstruction from a primary duodenal 
adenocarcinoma? How this can impact the outcome of the two different treatments? 
 Accept after discretionary revisions What next?: 
 An article of outstanding merit and interest in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that i have no competing interest 
Reviewer's report 
 Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review Title: 
 1  15 March 2007 Version: Date: 
 alessandro A repici Reviewer: 
Reviewer's report: 
General 
The manuscript from the Rotterdam group is an excellent and systematic review of the two different 
treatment modalities for palliation of gastric outlet obstruction. This manuscript covers an area in continuous 
updating for which there are no extablished guidelines and clinical approaches can vary depending on 
whom is taking care of the patient. So it is worthwhile this careful and objective evaluation of available data 
on literature. I appreciated the excellent analysis of the single outcomes and the objective discussion in 
which the weak points of the endoscopic approach (complication rate as high as surgical treatment, lack of 
long-term efficacy, etc) are correctly ruled out. Despite the fact that just a limited number of true randomized 
studies have been published, this review may allow to draw significant conclusions on what is the most 
appropriate approach for the different stages of disease leading to the gastric outlet obstruction. 
------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
no major revision are needed 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
no minor revision are needed 
------------------------------------------------------------------------------- Discretionary Revisions (which the author can choose to ignore) It could be useful, if possible, to compare the results of patients treated with uncovered versus covered 
stent. May the use of a covered stent afford a more prolonged benefit on luminal patency? This issue has 
been already proven for the esophageal cancer and it would be nice if the authors could mention this possibility in the discussion, even as potential improvement for the future. Moreover it would interesting to 
compare the outcomes of the two different approach basing on the cause of duodenal obstruction. Does the 
obstruction from a pancreatic cancer behaviour differently than an obstruction from a primary duodenal 
adenocarcinoma? How this can impact the outcome of the two different treatments? 
 Accept after discretionary revisions What next?: 
 An article of outstanding merit and interest in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that i have no competing interest 
Please review this paper.
user
Reviewer's report 
 Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review Title: 
 1  15 March 2007 Version: Date: 
 alessandro A repici Reviewer: 
Reviewer's report: 
General 
The manuscript from the Rotterdam group is an excellent and systematic review of the two different 
treatment modalities for palliation of gastric outlet obstruction. This manuscript covers an area in continuous 
updating for which there are no extablished guidelines and clinical approaches can vary depending on 
whom is taking care of the patient. So it is worthwhile this careful and objective evaluation of available data 
on literature. I appreciated the excellent analysis of the single outcomes and the objective discussion in 
which the weak points of the endoscopic approach (complication rate as high as surgical treatment, lack of 
long-term efficacy, etc) are correctly ruled out. Despite the fact that just a limited number of true randomized 
studies have been published, this review may allow to draw significant conclusions on what is the most 
appropriate approach for the different stages of disease leading to the gastric outlet obstruction. 
------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
no major revision are needed 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
no minor revision are needed 
------------------------------------------------------------------------------- Discretionary Revisions (which the author can choose to ignore) It could be useful, if possible, to compare the results of patients treated with uncovered versus covered 
stent. May the use of a covered stent afford a more prolonged benefit on luminal patency? This issue has 
been already proven for the esophageal cancer and it would be nice if the authors could mention this possibility in the discussion, even as potential improvement for the future. Moreover it would interesting to 
compare the outcomes of the two different approach basing on the cause of duodenal obstruction. Does the 
obstruction from a pancreatic cancer behaviour differently than an obstruction from a primary duodenal 
adenocarcinoma? How this can impact the outcome of the two different treatments? 
 Accept after discretionary revisions What next?: 
 An article of outstanding merit and interest in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that i have no competing interest 
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