Reviewer ’s report  
 
Title: Obstructive jaundice due to a blood clot after ERCP: a case report and review of the 
literature  
 
Version: 1 Date: 13 Dec 2017  
 
Reviewer: Seiko Hirono  
 
Reviewer's report:  
 
This manuscript reported the patients with bile duct stone who underwent removal of stone by 
ERCP procedure, and developed cholangitis caused by blood clot in common bile duct.   The 
author concluded that repeated ERCP procedures were effective for these patients.  I have some 
questions and comments about this manuscript.  
1) Did the author check complete hemostasis after initial ERCP procedure including EST and 
removal of stone?  Please add the picture of papilla Vater after ERCP procedure.  
 
2) Didn't the patient receive anticoagulant before and after initial ERCP procedure?  
 
3) According to the author's review, please comment the risk factor for cholangitis caused  by 
blood clot after ERCP procedure.  
 
4) Although the author described efficacy of repeated ERCP, ERCP is an invasive procedure, 
especially for old patients.  Therefore, the author should comment the strategy to avoid 
repeated ERCP procedures for these case s.   
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.  
 
Unable to assess  
 
  
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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 publi cation 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 curr ently 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 rep ort 
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 understa nd 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: Obstructive jaundice due to a blood clot after ERCP: a case report and review of the 
literature  
 
Version: 1 Date: 13 Dec 2017  
 
Reviewer: Seiko Hirono  
 
Reviewer's report:  
 
This manuscript reported the patients with bile duct stone who underwent removal of stone by 
ERCP procedure, and developed cholangitis caused by blood clot in common bile duct.   The 
author concluded that repeated ERCP procedures were effective for these patients.  I have some 
questions and comments about this manuscript.  
1) Did the author check complete hemostasis after initial ERCP procedure including EST and 
removal of stone?  Please add the picture of papilla Vater after ERCP procedure.  
 
2) Didn't the patient receive anticoagulant before and after initial ERCP procedure?  
 
3) According to the author's review, please comment the risk factor for cholangitis caused  by 
blood clot after ERCP procedure.  
 
4) Although the author described efficacy of repeated ERCP, ERCP is an invasive procedure, 
especially for old patients.  Therefore, the author should comment the strategy to avoid 
repeated ERCP procedures for these case s.   
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.  
 
Unable to assess  
 
  
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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 publi cation 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 curr ently 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 rep ort 
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 understa nd 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: Obstructive jaundice due to a blood clot after ERCP: a case report and review of the 
literature  
 
Version: 1 Date: 13 Dec 2017  
 
Reviewer: Seiko Hirono  
 
Reviewer's report:  
 
This manuscript reported the patients with bile duct stone who underwent removal of stone by 
ERCP procedure, and developed cholangitis caused by blood clot in common bile duct.   The 
author concluded that repeated ERCP procedures were effective for these patients.  I have some 
questions and comments about this manuscript.  
1) Did the author check complete hemostasis after initial ERCP procedure including EST and 
removal of stone?  Please add the picture of papilla Vater after ERCP procedure.  
 
2) Didn't the patient receive anticoagulant before and after initial ERCP procedure?  
 
3) According to the author's review, please comment the risk factor for cholangitis caused  by 
blood clot after ERCP procedure.  
 
4) Although the author described efficacy of repeated ERCP, ERCP is an invasive procedure, 
especially for old patients.  Therefore, the author should comment the strategy to avoid 
repeated ERCP procedures for these case s.   
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.  
 
Unable to assess  
 
  
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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 publi cation 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 curr ently 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 rep ort 
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 understa nd 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