Title: Management of post-operative pancreatic fistulas following Longmire-Traverso pylorus-
preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
Version: 2 Date: 13 Sep 2021
Reviewer's report:
Dear Editors and Authors,
thank you for the possibility to revise this Manuscript.
The study is well written, with a nice overview of the problem and the “unmet clinical needs”.
The authors describe the technique accurately, with adequate iconography and sufficient details
of the patients characteristics and outcomes. Moreover, they adequately discuss the limits of
their proof-of-concept study.
I suggest accepting this paper.
I have however the following comments:
Major:
- The term “Pancreatogastric Insufficiency” is somehow misleading (as for example it could
theoretically also describe an insufficiency due to a stenosis). Even if I perfectly understood the
concept, is this a universally accepted definition? Can other terms better describe the situation
(e.g. “pancreatogastric fistula or dehiscence or leak). Furthermore, notwithstanding the chosen
definition, the authors should formalize the definition with a sentence (as for example “In our
paper PI is defined as a continuity defect….”)
- Can you please further discuss the role of EVT in the bleeding of Patient 8? How was it
diagnosed? Did a CT scan show the source of the bleeding? Is the absence of upper GI bleeding
sufficient to exclude a role of EVT in this episode? I think the Authors should maintain a more
cautious attitude when discussing this point. Can the Authors also discuss the film versus sponge
topic in this case? Isn’t the sponge more traumatic? This (and the fact that a lower pressure [100
mmHg] was used) might corroborate the unlikelihood of a correlation. Also in the abstract the
“not related to EVT” should be smoothened for a more dubitative sentence. (e.g. There were no
adverse events directly attributable to EVT, but one patient… unlikely related… )
Minor:
- In the Introduciton, a “partial” pancreaticoduodenectomy sounds misleading;
pancreaticoduoenectomy is a partial pancreasectomy.
- Please tone down the term “promising” in the Discussion (it can be acceptable in the abstract
and conclusions). As perfectly underlined, the study has no “control” group and some of the
patients might have also recovered without EVT
Title: Management of post-operative pancreatic fistulas following Longmire-Traverso pylorus-
preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
Version: 2 Date: 13 Sep 2021
Reviewer's report:
Dear Editors and Authors,
thank you for the possibility to revise this Manuscript.
The study is well written, with a nice overview of the problem and the “unmet clinical needs”.
The authors describe the technique accurately, with adequate iconography and sufficient details
of the patients characteristics and outcomes. Moreover, they adequately discuss the limits of
their proof-of-concept study.
I suggest accepting this paper.
I have however the following comments:
Major:
- The term “Pancreatogastric Insufficiency” is somehow misleading (as for example it could
theoretically also describe an insufficiency due to a stenosis). Even if I perfectly understood the
concept, is this a universally accepted definition? Can other terms better describe the situation
(e.g. “pancreatogastric fistula or dehiscence or leak). Furthermore, notwithstanding the chosen
definition, the authors should formalize the definition with a sentence (as for example “In our
paper PI is defined as a continuity defect….”)
- Can you please further discuss the role of EVT in the bleeding of Patient 8? How was it
diagnosed? Did a CT scan show the source of the bleeding? Is the absence of upper GI bleeding
sufficient to exclude a role of EVT in this episode? I think the Authors should maintain a more
cautious attitude when discussing this point. Can the Authors also discuss the film versus sponge
topic in this case? Isn’t the sponge more traumatic? This (and the fact that a lower pressure [100
mmHg] was used) might corroborate the unlikelihood of a correlation. Also in the abstract the
“not related to EVT” should be smoothened for a more dubitative sentence. (e.g. There were no
adverse events directly attributable to EVT, but one patient… unlikely related… )
Minor:
- In the Introduciton, a “partial” pancreaticoduodenectomy sounds misleading;
pancreaticoduoenectomy is a partial pancreasectomy.
- Please tone down the term “promising” in the Discussion (it can be acceptable in the abstract
and conclusions). As perfectly underlined, the study has no “control” group and some of the
patients might have also recovered without EVT
Please review this paper.
user
Title: Management of post-operative pancreatic fistulas following Longmire-Traverso pylorus-
preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
Version: 2 Date: 13 Sep 2021
Reviewer's report:
Dear Editors and Authors,
thank you for the possibility to revise this Manuscript.
The study is well written, with a nice overview of the problem and the “unmet clinical needs”.
The authors describe the technique accurately, with adequate iconography and sufficient details
of the patients characteristics and outcomes. Moreover, they adequately discuss the limits of
their proof-of-concept study.
I suggest accepting this paper.
I have however the following comments:
Major:
- The term “Pancreatogastric Insufficiency” is somehow misleading (as for example it could
theoretically also describe an insufficiency due to a stenosis). Even if I perfectly understood the
concept, is this a universally accepted definition? Can other terms better describe the situation
(e.g. “pancreatogastric fistula or dehiscence or leak). Furthermore, notwithstanding the chosen
definition, the authors should formalize the definition with a sentence (as for example “In our
paper PI is defined as a continuity defect….”)
- Can you please further discuss the role of EVT in the bleeding of Patient 8? How was it
diagnosed? Did a CT scan show the source of the bleeding? Is the absence of upper GI bleeding
sufficient to exclude a role of EVT in this episode? I think the Authors should maintain a more
cautious attitude when discussing this point. Can the Authors also discuss the film versus sponge
topic in this case? Isn’t the sponge more traumatic? This (and the fact that a lower pressure [100
mmHg] was used) might corroborate the unlikelihood of a correlation. Also in the abstract the
“not related to EVT” should be smoothened for a more dubitative sentence. (e.g. There were no
adverse events directly attributable to EVT, but one patient… unlikely related… )
Minor:
- In the Introduciton, a “partial” pancreaticoduodenectomy sounds misleading;
pancreaticoduoenectomy is a partial pancreasectomy.
- Please tone down the term “promising” in the Discussion (it can be acceptable in the abstract
and conclusions). As perfectly underlined, the study has no “control” group and some of the
patients might have also recovered without EVT
assistant