Reviewer ’s report  
 
Title:  The modified pancreatic stent system for prevention of post -ERCP pancre atitis: a case -
control study  
 
Version: 0 Date: 11 Oct 2016 
 
Reviewer:  Amy  Tyberg  
 
Reviewer’s report:  
 
This is an interesting study looking at a new device for prophy lactic pancreatic stents. A few 
comments:  
 
1. I am concerned about the applicability of this new device as it can only be used in patients 
who receive nasobiliary catheters, which is a limited population.  
 
2. Patients have a habit of not tolerating nasobi liary tubes due to discomfort. Were any of these 
catheter dislodged or removed due to patient dissatisfaction?  
 
3. The proximal migration rate of pancreatic stents in this study seems surprisingly high.  
 
4. The authors mention that this device might provid e cost savings by negating the need for 
follow -up endoscopy. However, they fail to take into account the extra cost of the device itself as 
well as the extra procedure time required in the initial procedure to deploy it. I don't believe a 
statement about c ost savings can be made without incorporating these variables.  
 
5. Most prophylactic PD stents are removed with endoscopy, not with repeat ERCP. The 
conclusion statement that the new device "reduces pain of the patients and the costs associated 
with follow -up procedures" is not really accurate since patients do not have pain from EGD with 
stent removal.  
 
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.  
 
Yes 
 
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 edit ors. 
 
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 re ceived 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 i n 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 pe er 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 auth ors' 
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 d o 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:  The modified pancreatic stent system for prevention of post -ERCP pancre atitis: a case -
control study  
 
Version: 0 Date: 11 Oct 2016 
 
Reviewer:  Amy  Tyberg  
 
Reviewer’s report:  
 
This is an interesting study looking at a new device for prophy lactic pancreatic stents. A few 
comments:  
 
1. I am concerned about the applicability of this new device as it can only be used in patients 
who receive nasobiliary catheters, which is a limited population.  
 
2. Patients have a habit of not tolerating nasobi liary tubes due to discomfort. Were any of these 
catheter dislodged or removed due to patient dissatisfaction?  
 
3. The proximal migration rate of pancreatic stents in this study seems surprisingly high.  
 
4. The authors mention that this device might provid e cost savings by negating the need for 
follow -up endoscopy. However, they fail to take into account the extra cost of the device itself as 
well as the extra procedure time required in the initial procedure to deploy it. I don't believe a 
statement about c ost savings can be made without incorporating these variables.  
 
5. Most prophylactic PD stents are removed with endoscopy, not with repeat ERCP. The 
conclusion statement that the new device "reduces pain of the patients and the costs associated 
with follow -up procedures" is not really accurate since patients do not have pain from EGD with 
stent removal.  
 
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.  
 
Yes 
 
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 edit ors. 
 
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 re ceived 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 i n 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 pe er 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 auth ors' 
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 d o 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:  The modified pancreatic stent system for prevention of post -ERCP pancre atitis: a case -
control study  
 
Version: 0 Date: 11 Oct 2016 
 
Reviewer:  Amy  Tyberg  
 
Reviewer’s report:  
 
This is an interesting study looking at a new device for prophy lactic pancreatic stents. A few 
comments:  
 
1. I am concerned about the applicability of this new device as it can only be used in patients 
who receive nasobiliary catheters, which is a limited population.  
 
2. Patients have a habit of not tolerating nasobi liary tubes due to discomfort. Were any of these 
catheter dislodged or removed due to patient dissatisfaction?  
 
3. The proximal migration rate of pancreatic stents in this study seems surprisingly high.  
 
4. The authors mention that this device might provid e cost savings by negating the need for 
follow -up endoscopy. However, they fail to take into account the extra cost of the device itself as 
well as the extra procedure time required in the initial procedure to deploy it. I don't believe a 
statement about c ost savings can be made without incorporating these variables.  
 
5. Most prophylactic PD stents are removed with endoscopy, not with repeat ERCP. The 
conclusion statement that the new device "reduces pain of the patients and the costs associated 
with follow -up procedures" is not really accurate since patients do not have pain from EGD with 
stent removal.  
 
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.  
 
Yes 
 
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 edit ors. 
 
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 re ceived 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 i n 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 pe er 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 auth ors' 
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 d o 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