Title: Outcomes and limitations of endoscopic ultrasound-guided hepaticogastrostomy in
malignant biliary obstruction
Version: 1 Date: 13 Mar 2021
Reviewer's report:
The study entitled “Outcomes and limitations of endoscopic ultrasound-guided
hepaticogastrostomy in malignant biliary obstruction“  highlights the use of EUS-guided
endoscopic hepatogastrostomy for failed ERCP drainage for malignant biliary obstruction. This
technique is attractive and has several advantages over surgery.
While the authors study might be of great use for the current literature, several questions
regarding their proposal should be asked:
1. There is a clearly need of extensive English improvement as many of the ideas in the
manuscript are not fully understood due to poor English language.
For example, there irresectable should be replaced with unresectable
written consent to the proposed
etc.
2.  The Methods section
Authors mention this a prospective study and that it was approved by the Ethics Committee
which means that they should have an approval number. They should mention it.
All this section requires to be restructured. All the information provided is scattered with
no actual logic. They should separate this section accordingly, with Patient’s characteristics,
Inclusion criteria, Procedures, Statistics etc…
Line 136 EG38UT is an echoendoscope
Line 135 Endoscopic hepaticogastrostomy procedures (Figures 1A–E) – none of the selected
images focus on EUS characteriscs.
3. The results section
The authors use both endoscopic and endoscopic hepaticogastrostomy – they should decide on
one of them.
Asa mentioned above, this chapter also requires restructuring based on the results obtained either
by procedures, clinical success, complications, groups etc…
Line 232 Detailed clinical characteristics of the patients are presented in Table 1. When checking
the table, the data here is very scarce. Consider providing additional information or restructuring
the table.
Also, surely the authors can provide additional tables regarding their results.
4. Discussions
extrahepatic biliary tract access, via choledochoduodenostomy/cholecystoduodenostomy, to
intrahepatic access, via hepaticogastrostomy, the technical and clinical success rates are similar.
Whereas a higher number of complications are observed in patients with intrahepatic access.
[11,17]
Should be rephrased
Line 327 to 330 perhaps the authors should only use the conclusion that the procedure should
be performed in experienced centers
Line 331 but may also be used first-line treatment. Pulling this conclusion is rather hasty and in
contradiction with the one above, regarding performing it in dedicated centers.
The limitations should also include that cost analysis was not performed and a long follow-up
was not assessed.
Title: Outcomes and limitations of endoscopic ultrasound-guided hepaticogastrostomy in
malignant biliary obstruction
Version: 1 Date: 13 Mar 2021
Reviewer's report:
The study entitled “Outcomes and limitations of endoscopic ultrasound-guided
hepaticogastrostomy in malignant biliary obstruction“  highlights the use of EUS-guided
endoscopic hepatogastrostomy for failed ERCP drainage for malignant biliary obstruction. This
technique is attractive and has several advantages over surgery.
While the authors study might be of great use for the current literature, several questions
regarding their proposal should be asked:
1. There is a clearly need of extensive English improvement as many of the ideas in the
manuscript are not fully understood due to poor English language.
For example, there irresectable should be replaced with unresectable
written consent to the proposed
etc.
2.  The Methods section
Authors mention this a prospective study and that it was approved by the Ethics Committee
which means that they should have an approval number. They should mention it.
All this section requires to be restructured. All the information provided is scattered with
no actual logic. They should separate this section accordingly, with Patient’s characteristics,
Inclusion criteria, Procedures, Statistics etc…
Line 136 EG38UT is an echoendoscope
Line 135 Endoscopic hepaticogastrostomy procedures (Figures 1A–E) – none of the selected
images focus on EUS characteriscs.
3. The results section
The authors use both endoscopic and endoscopic hepaticogastrostomy – they should decide on
one of them.
Asa mentioned above, this chapter also requires restructuring based on the results obtained either
by procedures, clinical success, complications, groups etc…
Line 232 Detailed clinical characteristics of the patients are presented in Table 1. When checking
the table, the data here is very scarce. Consider providing additional information or restructuring
the table.
Also, surely the authors can provide additional tables regarding their results.
4. Discussions
extrahepatic biliary tract access, via choledochoduodenostomy/cholecystoduodenostomy, to
intrahepatic access, via hepaticogastrostomy, the technical and clinical success rates are similar.
Whereas a higher number of complications are observed in patients with intrahepatic access.
[11,17]
Should be rephrased
Line 327 to 330 perhaps the authors should only use the conclusion that the procedure should
be performed in experienced centers
Line 331 but may also be used first-line treatment. Pulling this conclusion is rather hasty and in
contradiction with the one above, regarding performing it in dedicated centers.
The limitations should also include that cost analysis was not performed and a long follow-up
was not assessed.
Please review this paper.
user
Title: Outcomes and limitations of endoscopic ultrasound-guided hepaticogastrostomy in
malignant biliary obstruction
Version: 1 Date: 13 Mar 2021
Reviewer's report:
The study entitled “Outcomes and limitations of endoscopic ultrasound-guided
hepaticogastrostomy in malignant biliary obstruction“  highlights the use of EUS-guided
endoscopic hepatogastrostomy for failed ERCP drainage for malignant biliary obstruction. This
technique is attractive and has several advantages over surgery.
While the authors study might be of great use for the current literature, several questions
regarding their proposal should be asked:
1. There is a clearly need of extensive English improvement as many of the ideas in the
manuscript are not fully understood due to poor English language.
For example, there irresectable should be replaced with unresectable
written consent to the proposed
etc.
2.  The Methods section
Authors mention this a prospective study and that it was approved by the Ethics Committee
which means that they should have an approval number. They should mention it.
All this section requires to be restructured. All the information provided is scattered with
no actual logic. They should separate this section accordingly, with Patient’s characteristics,
Inclusion criteria, Procedures, Statistics etc…
Line 136 EG38UT is an echoendoscope
Line 135 Endoscopic hepaticogastrostomy procedures (Figures 1A–E) – none of the selected
images focus on EUS characteriscs.
3. The results section
The authors use both endoscopic and endoscopic hepaticogastrostomy – they should decide on
one of them.
Asa mentioned above, this chapter also requires restructuring based on the results obtained either
by procedures, clinical success, complications, groups etc…
Line 232 Detailed clinical characteristics of the patients are presented in Table 1. When checking
the table, the data here is very scarce. Consider providing additional information or restructuring
the table.
Also, surely the authors can provide additional tables regarding their results.
4. Discussions
extrahepatic biliary tract access, via choledochoduodenostomy/cholecystoduodenostomy, to
intrahepatic access, via hepaticogastrostomy, the technical and clinical success rates are similar.
Whereas a higher number of complications are observed in patients with intrahepatic access.
[11,17]
Should be rephrased
Line 327 to 330 perhaps the authors should only use the conclusion that the procedure should
be performed in experienced centers
Line 331 but may also be used first-line treatment. Pulling this conclusion is rather hasty and in
contradiction with the one above, regarding performing it in dedicated centers.
The limitations should also include that cost analysis was not performed and a long follow-up
was not assessed.
assistant