Reviewer’s report
Title: 
Percutaneous direct pancreatic duct intervention in management of
pancreatic fistulas: A primary treatment or temporizing therapy to prepare for
elective surgery.
Version: 
1 
Date: 
08 Oct 2020
Reviewer's report:
Dear authors,
first of all I want to thank you for the opportunity to review your interesting
work. The percutaneous pancreatic duct intervention is a technique seldom
reported. Increase the information available on it is a worth aim.
Unfortunately I have some major concerns in the conclusions you draw from you
experience.
Major concerns:
- Your population is extremely heterogeneous. Describe it is of paramount
interest but draw any clinical conclusion on the effectiveness of the technique
could be considered too speculative. You have in 10 cases 3 different type of
patients/settings (after PD, after distal pancreatectomy and after acute
pancreatitis) and at least 5 different types of approach you cannot considered
them as one population, it is more a collection of clinical cases.
- From the point of view of a surgeon a complex procedure as yours cannot be
considered a "bridge to surgery", it could be define effective if surgery is
avoided. You describe a chronic setting in which clinician and surgeons are try
to end or shorten the fistula presence without surgery, be a bridge to surgery
means that the technique had been not useful. Describe it as a success is at least
peculiar from my point of view.
- In one of your cases the fistula persists for 117 days after the procedure, you
cannot consider it as a success. In 4 month a fistula can close spontaneously.
Also you cannot use the only case in which the catheterization failed as a
comparison or an example in the discussion. It Is methodologically incorrect,
you can compare the results with other patients of your cohort and literature.
Many high volume centers that don't have experience in these percutaneous
techniques reported in the last 20 years their experience and one year of fistula
persistence is an almost unique case.
Minor concerns:
- You have to report the initial population from which you selected these 19
cases. 8 years practice in a high volume center should have produce an
enormous amount of cases and the 10 you reported could be extremely unique.
Draw from them absolute conclusion on effectiveness is in my opinion too
speculative.
- I think you should better explain what you mean by "for palliative intent in
terminally ill patients". It need some details. In the worst case scenario the reader
could think that you have made a complex procedure in a patient that needs only
supportive therapy (therapeutic futility).
Best regards
Publons Reviewer Recognition
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review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
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Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
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Yes
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Percutaneous direct pancreatic duct intervention in management of
pancreatic fistulas: A primary treatment or temporizing therapy to prepare for
elective surgery.
Version: 
1 
Date: 
08 Oct 2020
Reviewer's report:
Dear authors,
first of all I want to thank you for the opportunity to review your interesting
work. The percutaneous pancreatic duct intervention is a technique seldom
reported. Increase the information available on it is a worth aim.
Unfortunately I have some major concerns in the conclusions you draw from you
experience.
Major concerns:
- Your population is extremely heterogeneous. Describe it is of paramount
interest but draw any clinical conclusion on the effectiveness of the technique
could be considered too speculative. You have in 10 cases 3 different type of
patients/settings (after PD, after distal pancreatectomy and after acute
pancreatitis) and at least 5 different types of approach you cannot considered
them as one population, it is more a collection of clinical cases.
- From the point of view of a surgeon a complex procedure as yours cannot be
considered a "bridge to surgery", it could be define effective if surgery is
avoided. You describe a chronic setting in which clinician and surgeons are try
to end or shorten the fistula presence without surgery, be a bridge to surgery
means that the technique had been not useful. Describe it as a success is at least
peculiar from my point of view.
- In one of your cases the fistula persists for 117 days after the procedure, you
cannot consider it as a success. In 4 month a fistula can close spontaneously.
Also you cannot use the only case in which the catheterization failed as a
comparison or an example in the discussion. It Is methodologically incorrect,
you can compare the results with other patients of your cohort and literature.
Many high volume centers that don't have experience in these percutaneous
techniques reported in the last 20 years their experience and one year of fistula
persistence is an almost unique case.
Minor concerns:
- You have to report the initial population from which you selected these 19
cases. 8 years practice in a high volume center should have produce an
enormous amount of cases and the 10 you reported could be extremely unique.
Draw from them absolute conclusion on effectiveness is in my opinion too
speculative.
- I think you should better explain what you mean by "for palliative intent in
terminally ill patients". It need some details. In the worst case scenario the reader
could think that you have made a complex procedure in a patient that needs only
supportive therapy (therapeutic futility).
Best regards
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Percutaneous direct pancreatic duct intervention in management of
pancreatic fistulas: A primary treatment or temporizing therapy to prepare for
elective surgery.
Version: 
1 
Date: 
08 Oct 2020
Reviewer's report:
Dear authors,
first of all I want to thank you for the opportunity to review your interesting
work. The percutaneous pancreatic duct intervention is a technique seldom
reported. Increase the information available on it is a worth aim.
Unfortunately I have some major concerns in the conclusions you draw from you
experience.
Major concerns:
- Your population is extremely heterogeneous. Describe it is of paramount
interest but draw any clinical conclusion on the effectiveness of the technique
could be considered too speculative. You have in 10 cases 3 different type of
patients/settings (after PD, after distal pancreatectomy and after acute
pancreatitis) and at least 5 different types of approach you cannot considered
them as one population, it is more a collection of clinical cases.
- From the point of view of a surgeon a complex procedure as yours cannot be
considered a "bridge to surgery", it could be define effective if surgery is
avoided. You describe a chronic setting in which clinician and surgeons are try
to end or shorten the fistula presence without surgery, be a bridge to surgery
means that the technique had been not useful. Describe it as a success is at least
peculiar from my point of view.
- In one of your cases the fistula persists for 117 days after the procedure, you
cannot consider it as a success. In 4 month a fistula can close spontaneously.
Also you cannot use the only case in which the catheterization failed as a
comparison or an example in the discussion. It Is methodologically incorrect,
you can compare the results with other patients of your cohort and literature.
Many high volume centers that don't have experience in these percutaneous
techniques reported in the last 20 years their experience and one year of fistula
persistence is an almost unique case.
Minor concerns:
- You have to report the initial population from which you selected these 19
cases. 8 years practice in a high volume center should have produce an
enormous amount of cases and the 10 you reported could be extremely unique.
Draw from them absolute conclusion on effectiveness is in my opinion too
speculative.
- I think you should better explain what you mean by "for palliative intent in
terminally ill patients". It need some details. In the worst case scenario the reader
could think that you have made a complex procedure in a patient that needs only
supportive therapy (therapeutic futility).
Best regards
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant