Title: Stenting of the pancreatic duct in the early phase of acute pancreatitis: a retrospective
study
Version: 0 Date: 27 Jul 2022
Reviewer:  Áron Vincze
Reviewer's report:
This is a retrospective cohort study involving 131 acute pancreatitis patients. Group of patients
had ERCP with PD stent within 48 hours after admission (study group, n=46), while the rest
of the patients did not receive pancreatic stent (control group). The primary endpoints were the
complications (ERCP related, new onset organ failure, new systemic and local complications,
outcome at 2 months). There was no significant differences between the two groups. Favorable
differences were found in the secondary endpoints (time of pain relief, time of oral refeeding,
length of hospital stay, length of ICU stay in the study group.
Major concerns:
1) The etiology of the pancreatitis not detailed in the two groups, however significantly more
cases of biliary pancreatitis were in the study group, as it shown in Table 1.
2) The exact indication of ERCP is not clearly explained.
3) How many patients had ERCP without pancreatic duct stenting in the two groups?
4) What was the biliary cannulation failure rate, pancreatic stenting failure rate during the
ERCPs?
5) Were there any advanced cannulation techniques applied during the ERCPs?
6) Why were different stent types used in the study? Only prophylactic (5 Fr), short stents might
be indicated in selected cases during ERCP in patients without chronic pacreatitis. Chronic
pancreatitis patients were excluded from the study. What was the indication of larger calibre,
longer pancreatic stents?
7) Because all of these concerns, the study group itself is very heterogeneous, the study and the
control group is not really comparable.
Minor concers:
1) The English language should be improved, lots of imprecise sentences along the manuscript
2) The case load of endoscopists who performed the ERCPs in the study requires some
explanation. It is stated that the endoscopists performed more than 500 ERCP and more than
500 pancreatic cannulation yearly. The latter is unusually high number, since the majority of
ERCPs have biliary indications, when pancreatic cannulation is not required.
3) What is the indication of preprocedural intramusculars phloroglucinol?
4) Were there any prophylactic measures (i.e., NSAID, iv hydrations) applied to prevent post-
ERCP pancreatitis, other than pancreatic stenting?
5) Data cleaning and processing in the Methods part are not clear. What happened with the
missing values?
6) Reference 13 and 24 are the same
7) Reference 28 author list is not correct
Title: Stenting of the pancreatic duct in the early phase of acute pancreatitis: a retrospective
study
Version: 0 Date: 27 Jul 2022
Reviewer:  Áron Vincze
Reviewer's report:
This is a retrospective cohort study involving 131 acute pancreatitis patients. Group of patients
had ERCP with PD stent within 48 hours after admission (study group, n=46), while the rest
of the patients did not receive pancreatic stent (control group). The primary endpoints were the
complications (ERCP related, new onset organ failure, new systemic and local complications,
outcome at 2 months). There was no significant differences between the two groups. Favorable
differences were found in the secondary endpoints (time of pain relief, time of oral refeeding,
length of hospital stay, length of ICU stay in the study group.
Major concerns:
1) The etiology of the pancreatitis not detailed in the two groups, however significantly more
cases of biliary pancreatitis were in the study group, as it shown in Table 1.
2) The exact indication of ERCP is not clearly explained.
3) How many patients had ERCP without pancreatic duct stenting in the two groups?
4) What was the biliary cannulation failure rate, pancreatic stenting failure rate during the
ERCPs?
5) Were there any advanced cannulation techniques applied during the ERCPs?
6) Why were different stent types used in the study? Only prophylactic (5 Fr), short stents might
be indicated in selected cases during ERCP in patients without chronic pacreatitis. Chronic
pancreatitis patients were excluded from the study. What was the indication of larger calibre,
longer pancreatic stents?
7) Because all of these concerns, the study group itself is very heterogeneous, the study and the
control group is not really comparable.
Minor concers:
1) The English language should be improved, lots of imprecise sentences along the manuscript
2) The case load of endoscopists who performed the ERCPs in the study requires some
explanation. It is stated that the endoscopists performed more than 500 ERCP and more than
500 pancreatic cannulation yearly. The latter is unusually high number, since the majority of
ERCPs have biliary indications, when pancreatic cannulation is not required.
3) What is the indication of preprocedural intramusculars phloroglucinol?
4) Were there any prophylactic measures (i.e., NSAID, iv hydrations) applied to prevent post-
ERCP pancreatitis, other than pancreatic stenting?
5) Data cleaning and processing in the Methods part are not clear. What happened with the
missing values?
6) Reference 13 and 24 are the same
7) Reference 28 author list is not correct
Please review this paper.
user
Title: Stenting of the pancreatic duct in the early phase of acute pancreatitis: a retrospective
study
Version: 0 Date: 27 Jul 2022
Reviewer:  Áron Vincze
Reviewer's report:
This is a retrospective cohort study involving 131 acute pancreatitis patients. Group of patients
had ERCP with PD stent within 48 hours after admission (study group, n=46), while the rest
of the patients did not receive pancreatic stent (control group). The primary endpoints were the
complications (ERCP related, new onset organ failure, new systemic and local complications,
outcome at 2 months). There was no significant differences between the two groups. Favorable
differences were found in the secondary endpoints (time of pain relief, time of oral refeeding,
length of hospital stay, length of ICU stay in the study group.
Major concerns:
1) The etiology of the pancreatitis not detailed in the two groups, however significantly more
cases of biliary pancreatitis were in the study group, as it shown in Table 1.
2) The exact indication of ERCP is not clearly explained.
3) How many patients had ERCP without pancreatic duct stenting in the two groups?
4) What was the biliary cannulation failure rate, pancreatic stenting failure rate during the
ERCPs?
5) Were there any advanced cannulation techniques applied during the ERCPs?
6) Why were different stent types used in the study? Only prophylactic (5 Fr), short stents might
be indicated in selected cases during ERCP in patients without chronic pacreatitis. Chronic
pancreatitis patients were excluded from the study. What was the indication of larger calibre,
longer pancreatic stents?
7) Because all of these concerns, the study group itself is very heterogeneous, the study and the
control group is not really comparable.
Minor concers:
1) The English language should be improved, lots of imprecise sentences along the manuscript
2) The case load of endoscopists who performed the ERCPs in the study requires some
explanation. It is stated that the endoscopists performed more than 500 ERCP and more than
500 pancreatic cannulation yearly. The latter is unusually high number, since the majority of
ERCPs have biliary indications, when pancreatic cannulation is not required.
3) What is the indication of preprocedural intramusculars phloroglucinol?
4) Were there any prophylactic measures (i.e., NSAID, iv hydrations) applied to prevent post-
ERCP pancreatitis, other than pancreatic stenting?
5) Data cleaning and processing in the Methods part are not clear. What happened with the
missing values?
6) Reference 13 and 24 are the same
7) Reference 28 author list is not correct
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