Title: Diagnostic yield of endoscopic ultrasound in dilated common bile duct with non-
diagnostic cross-sectional imaging
Version: 2 Date: 10 Jul 2024
Reviewer's report:
I appreciate your invitation to review for BMC Gastroenterology.
This is a study of outcomes of EUS in the dilatation of BD. This is a very interesting subject for
a pancreato-biliary endoscopist, and I have a number of queries for the authors.
1) I think that ampullary mass can be diagnosed by endoscopy instead of EUS. Are you referring
to cases in which EUS was performed in cases with negative endoscopic findings?
2) Please describe the definition of bile duct dilation. How many millimeters or more is
considered a finding of dilation, and less than 10 mm cannot be defined as dilation?
3) We believe that 6 months follow-up after the examination is too short; please provide the
rationale for the 6 month follow-up.
4) The diagnostic performance of EUS for jaundice cases is stated to be high. We believe that
if jaundice is present, lesions are usually detected on thin-slice CT and MRI of 3T or higher.
We believe that CT and MRI should be performed again for these cases. Does this mean that
the lesion was not detected on the re-examination CT and MRI? In any case, please illustrate
the examination protocol.
5) Some bile duct lesions are difficult to diagnose by EUS alone; how many cases are
additionally examined by ERCP? ERCP is usually performed for treatment purposes, especially
in jaundice cases, and ERC images can change the diagnosis made by EUS.
6) On the point of Accuracy, EUS findings alone are a rather opaque argument. EUS-TA is
indispensable for the diagnosis of pancreatic cancer, and it is necessary to specify how many
cases of EUS-TA were actually performed. It is necessary to specify how many patients actually
underwent EUS-TA.
Title: Diagnostic yield of endoscopic ultrasound in dilated common bile duct with non-
diagnostic cross-sectional imaging
Version: 2 Date: 10 Jul 2024
Reviewer's report:
I appreciate your invitation to review for BMC Gastroenterology.
This is a study of outcomes of EUS in the dilatation of BD. This is a very interesting subject for
a pancreato-biliary endoscopist, and I have a number of queries for the authors.
1) I think that ampullary mass can be diagnosed by endoscopy instead of EUS. Are you referring
to cases in which EUS was performed in cases with negative endoscopic findings?
2) Please describe the definition of bile duct dilation. How many millimeters or more is
considered a finding of dilation, and less than 10 mm cannot be defined as dilation?
3) We believe that 6 months follow-up after the examination is too short; please provide the
rationale for the 6 month follow-up.
4) The diagnostic performance of EUS for jaundice cases is stated to be high. We believe that
if jaundice is present, lesions are usually detected on thin-slice CT and MRI of 3T or higher.
We believe that CT and MRI should be performed again for these cases. Does this mean that
the lesion was not detected on the re-examination CT and MRI? In any case, please illustrate
the examination protocol.
5) Some bile duct lesions are difficult to diagnose by EUS alone; how many cases are
additionally examined by ERCP? ERCP is usually performed for treatment purposes, especially
in jaundice cases, and ERC images can change the diagnosis made by EUS.
6) On the point of Accuracy, EUS findings alone are a rather opaque argument. EUS-TA is
indispensable for the diagnosis of pancreatic cancer, and it is necessary to specify how many
cases of EUS-TA were actually performed. It is necessary to specify how many patients actually
underwent EUS-TA.
Please review this paper.
user
Title: Diagnostic yield of endoscopic ultrasound in dilated common bile duct with non-
diagnostic cross-sectional imaging
Version: 2 Date: 10 Jul 2024
Reviewer's report:
I appreciate your invitation to review for BMC Gastroenterology.
This is a study of outcomes of EUS in the dilatation of BD. This is a very interesting subject for
a pancreato-biliary endoscopist, and I have a number of queries for the authors.
1) I think that ampullary mass can be diagnosed by endoscopy instead of EUS. Are you referring
to cases in which EUS was performed in cases with negative endoscopic findings?
2) Please describe the definition of bile duct dilation. How many millimeters or more is
considered a finding of dilation, and less than 10 mm cannot be defined as dilation?
3) We believe that 6 months follow-up after the examination is too short; please provide the
rationale for the 6 month follow-up.
4) The diagnostic performance of EUS for jaundice cases is stated to be high. We believe that
if jaundice is present, lesions are usually detected on thin-slice CT and MRI of 3T or higher.
We believe that CT and MRI should be performed again for these cases. Does this mean that
the lesion was not detected on the re-examination CT and MRI? In any case, please illustrate
the examination protocol.
5) Some bile duct lesions are difficult to diagnose by EUS alone; how many cases are
additionally examined by ERCP? ERCP is usually performed for treatment purposes, especially
in jaundice cases, and ERC images can change the diagnosis made by EUS.
6) On the point of Accuracy, EUS findings alone are a rather opaque argument. EUS-TA is
indispensable for the diagnosis of pancreatic cancer, and it is necessary to specify how many
cases of EUS-TA were actually performed. It is necessary to specify how many patients actually
underwent EUS-TA.
assistant