Reviewer’s report
Title: A novel approach with holmium laser ablation for endoscopic management of intrahepatic biliary
stricture
Version: 0 Date: 26 Aug 2019
Reviewer: Theodoros Androutsakos
Reviewer's report:
First of all congratulations for your work. I think that the duration of follow up of your patients is a
plus, since for a disease like hepatolithiasis, short-term follow up is useless. However I think you need
to do some changes before your work is ready for publication. 
First of all, in background, you write that hepatolithiasis is a common disease, which is correct for Asia
(with high, though declining, incidence rates) but false for western countries, where hepatolithiasis is
rare. Moreover  I think you should add the fact that hepatolithiasis is an established risk factor for
cholangiocarcinoma (the most severe of its complications).
Secondly,  since  this  is  a  retrospective  study I  think  you  should  add  why the  approach  using  a
holmium:yttrium aluminum-garnet (Ho:YAG) surgical laser was chosen as a 2nd or 3rd line approach
to these patients. Is this the standard procedure in your hospital or where there other patients that were
treated in another way? IF that is the case, why ?
The methods section is well written and the prescription of the procedure is adequate.
In the results section you write that 3 patients developed after the procedure abdominal distention, fever
or diarrhea. I don't understand how many developed each of the symptoms (did all 3 had fever and
diarrhea??). Moreover abdominal distention is a result of something, t.ex. ileus or ascites and not a
disease, so I would suggest either reform the sentence or provide more details. 
I am also curious about the cirrhotic patient. What was the cause of crrhosis? Plus the patient 'passed
away' and not 'expired' most probably due to 'variceal bleeding' and not due to 'acute esophageal
varices'.
Last but not least, you need to re-check written english quality of your work. 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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
I agree to the open peer review policy of the journal. I understand that my name will be included on my
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. 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/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal
Reviewer’s report
Title: A novel approach with holmium laser ablation for endoscopic management of intrahepatic biliary
stricture
Version: 0 Date: 26 Aug 2019
Reviewer: Theodoros Androutsakos
Reviewer's report:
First of all congratulations for your work. I think that the duration of follow up of your patients is a
plus, since for a disease like hepatolithiasis, short-term follow up is useless. However I think you need
to do some changes before your work is ready for publication. 
First of all, in background, you write that hepatolithiasis is a common disease, which is correct for Asia
(with high, though declining, incidence rates) but false for western countries, where hepatolithiasis is
rare. Moreover  I think you should add the fact that hepatolithiasis is an established risk factor for
cholangiocarcinoma (the most severe of its complications).
Secondly,  since  this  is  a  retrospective  study I  think  you  should  add  why the  approach  using  a
holmium:yttrium aluminum-garnet (Ho:YAG) surgical laser was chosen as a 2nd or 3rd line approach
to these patients. Is this the standard procedure in your hospital or where there other patients that were
treated in another way? IF that is the case, why ?
The methods section is well written and the prescription of the procedure is adequate.
In the results section you write that 3 patients developed after the procedure abdominal distention, fever
or diarrhea. I don't understand how many developed each of the symptoms (did all 3 had fever and
diarrhea??). Moreover abdominal distention is a result of something, t.ex. ileus or ascites and not a
disease, so I would suggest either reform the sentence or provide more details. 
I am also curious about the cirrhotic patient. What was the cause of crrhosis? Plus the patient 'passed
away' and not 'expired' most probably due to 'variceal bleeding' and not due to 'acute esophageal
varices'.
Last but not least, you need to re-check written english quality of your work. 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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
I agree to the open peer review policy of the journal. I understand that my name will be included on my
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. 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/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal
Please review this paper.
user
Reviewer’s report
Title: A novel approach with holmium laser ablation for endoscopic management of intrahepatic biliary
stricture
Version: 0 Date: 26 Aug 2019
Reviewer: Theodoros Androutsakos
Reviewer's report:
First of all congratulations for your work. I think that the duration of follow up of your patients is a
plus, since for a disease like hepatolithiasis, short-term follow up is useless. However I think you need
to do some changes before your work is ready for publication. 
First of all, in background, you write that hepatolithiasis is a common disease, which is correct for Asia
(with high, though declining, incidence rates) but false for western countries, where hepatolithiasis is
rare. Moreover  I think you should add the fact that hepatolithiasis is an established risk factor for
cholangiocarcinoma (the most severe of its complications).
Secondly,  since  this  is  a  retrospective  study I  think  you  should  add  why the  approach  using  a
holmium:yttrium aluminum-garnet (Ho:YAG) surgical laser was chosen as a 2nd or 3rd line approach
to these patients. Is this the standard procedure in your hospital or where there other patients that were
treated in another way? IF that is the case, why ?
The methods section is well written and the prescription of the procedure is adequate.
In the results section you write that 3 patients developed after the procedure abdominal distention, fever
or diarrhea. I don't understand how many developed each of the symptoms (did all 3 had fever and
diarrhea??). Moreover abdominal distention is a result of something, t.ex. ileus or ascites and not a
disease, so I would suggest either reform the sentence or provide more details. 
I am also curious about the cirrhotic patient. What was the cause of crrhosis? Plus the patient 'passed
away' and not 'expired' most probably due to 'variceal bleeding' and not due to 'acute esophageal
varices'.
Last but not least, you need to re-check written english quality of your work. 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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
I agree to the open peer review policy of the journal. I understand that my name will be included on my
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. 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/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal
assistant