Title: Prognostic nomogram for acute pancreatitis after percutaneous biliary stent insertion in
patients with malignant obstruction
Version: 1 Date: 29 Aug 2022
Reviewer's report:
This article was a study of risk evaluation for pancreatitis after PTBS with a nomogram. And this
study demonstrated the efficacy of the nomogram with internal validation. Although this result is
interesting, this study has some problems in the outcomes, patients enrollment, and uniqueness.
1. This study was performed by retrospective review, and it must have been difficult to obtain
informed consent. For example, if a patient had undergone PTBD for MOJ in July 2016, he or she
might not have been able to agree with the study enrollment, considering the expected survival.
Please clarified the IRB approval number, and the process for obtaining informed consent.
2. The rate of post-procedural pancreatitis is high in this study, comparing the previous studies.
The reason why the rate of pancreatitis was different should be discussed in the Discussion
session.
3. The incidence and risk factors of pancreatitis after percutaneous SEMS placement in patients
with MBO have been evaluated in a previous study (Yang et al., Hepatobiliary Pancreat Dis Int.
2020). Authors developed a new nomogram for post-PTBS pancreatitis, but internal validation
with bootstrap resampling using the study population was not that meaningful. I think it is
mandatory to perform the “external validation” in the independent population, such as different
hospital or nation.
4. According the method in this manuscript, the SEMSs were placed right after percutaneous
puncture. However, although the evidence is insufficient, there is some concern about PTBD
tract injury if the SEMSs were inserted right after puncture. Weren’t there any complications at
the PTBD tract, such as bile leak, bleeding, pneumoperitoneum, or pneumothorax?
Title: Prognostic nomogram for acute pancreatitis after percutaneous biliary stent insertion in
patients with malignant obstruction
Version: 1 Date: 29 Aug 2022
Reviewer's report:
This article was a study of risk evaluation for pancreatitis after PTBS with a nomogram. And this
study demonstrated the efficacy of the nomogram with internal validation. Although this result is
interesting, this study has some problems in the outcomes, patients enrollment, and uniqueness.
1. This study was performed by retrospective review, and it must have been difficult to obtain
informed consent. For example, if a patient had undergone PTBD for MOJ in July 2016, he or she
might not have been able to agree with the study enrollment, considering the expected survival.
Please clarified the IRB approval number, and the process for obtaining informed consent.
2. The rate of post-procedural pancreatitis is high in this study, comparing the previous studies.
The reason why the rate of pancreatitis was different should be discussed in the Discussion
session.
3. The incidence and risk factors of pancreatitis after percutaneous SEMS placement in patients
with MBO have been evaluated in a previous study (Yang et al., Hepatobiliary Pancreat Dis Int.
2020). Authors developed a new nomogram for post-PTBS pancreatitis, but internal validation
with bootstrap resampling using the study population was not that meaningful. I think it is
mandatory to perform the “external validation” in the independent population, such as different
hospital or nation.
4. According the method in this manuscript, the SEMSs were placed right after percutaneous
puncture. However, although the evidence is insufficient, there is some concern about PTBD
tract injury if the SEMSs were inserted right after puncture. Weren’t there any complications at
the PTBD tract, such as bile leak, bleeding, pneumoperitoneum, or pneumothorax?
Please review this paper.
user
Title: Prognostic nomogram for acute pancreatitis after percutaneous biliary stent insertion in
patients with malignant obstruction
Version: 1 Date: 29 Aug 2022
Reviewer's report:
This article was a study of risk evaluation for pancreatitis after PTBS with a nomogram. And this
study demonstrated the efficacy of the nomogram with internal validation. Although this result is
interesting, this study has some problems in the outcomes, patients enrollment, and uniqueness.
1. This study was performed by retrospective review, and it must have been difficult to obtain
informed consent. For example, if a patient had undergone PTBD for MOJ in July 2016, he or she
might not have been able to agree with the study enrollment, considering the expected survival.
Please clarified the IRB approval number, and the process for obtaining informed consent.
2. The rate of post-procedural pancreatitis is high in this study, comparing the previous studies.
The reason why the rate of pancreatitis was different should be discussed in the Discussion
session.
3. The incidence and risk factors of pancreatitis after percutaneous SEMS placement in patients
with MBO have been evaluated in a previous study (Yang et al., Hepatobiliary Pancreat Dis Int.
2020). Authors developed a new nomogram for post-PTBS pancreatitis, but internal validation
with bootstrap resampling using the study population was not that meaningful. I think it is
mandatory to perform the “external validation” in the independent population, such as different
hospital or nation.
4. According the method in this manuscript, the SEMSs were placed right after percutaneous
puncture. However, although the evidence is insufficient, there is some concern about PTBD
tract injury if the SEMSs were inserted right after puncture. Weren’t there any complications at
the PTBD tract, such as bile leak, bleeding, pneumoperitoneum, or pneumothorax?
assistant