Reviewer's report
Title:Sequential algorithm analysis to facilitate selective biliary access for difficult
biliary cannulation in ERCP: a prospective clinical study
Version:1Date:27 January 2014
Reviewer: Gernot Sellge
Reviewer's report:
The paper reports on a prospective case series of ERCPs using a sequential
protocol in situations with difficult biliary cannulation (DBC). The authors describe
an algorithm consisting of double guidewire cannulation followed by precut after
placement of a pancreatic stent in patients with unintentional pancreatic duct
cannulation and early precut fistulotomy in patients with DBC for other reasons.
DBC criteria were relatively strict (e.g. cannulation time > 5min) compared to
other studies. The procedure performed by a single experienced endoscopist
lead to successful cannulation in 136/140 patients and was overall save.
Although the study design did not compare different strategies, the case series
describes a safe and feasible step by step algorithm for DBC. The patient
numbers are sufficient, and the procedures and criteria are clearly described and
seem to be well controlled. The study may help other endoscopists in choosing
the right strategy in DBC situations and is in my opinion suitable for publication in
BMC Gastroenterology.
Minor points:
1. Abbreviations are not always defined at the first appearance in the text (e.g.
CBD page 4 or PD page 6)
2. Although the authors clearly state that complications were classified and
graded according the consensus guidelines, it might be helpful for the reader if
the criteria for mild, moderate and severe pancreatitis would be shortly
described.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Sequential algorithm analysis to facilitate selective biliary access for difficult
biliary cannulation in ERCP: a prospective clinical study
Version:1Date:27 January 2014
Reviewer: Gernot Sellge
Reviewer's report:
The paper reports on a prospective case series of ERCPs using a sequential
protocol in situations with difficult biliary cannulation (DBC). The authors describe
an algorithm consisting of double guidewire cannulation followed by precut after
placement of a pancreatic stent in patients with unintentional pancreatic duct
cannulation and early precut fistulotomy in patients with DBC for other reasons.
DBC criteria were relatively strict (e.g. cannulation time > 5min) compared to
other studies. The procedure performed by a single experienced endoscopist
lead to successful cannulation in 136/140 patients and was overall save.
Although the study design did not compare different strategies, the case series
describes a safe and feasible step by step algorithm for DBC. The patient
numbers are sufficient, and the procedures and criteria are clearly described and
seem to be well controlled. The study may help other endoscopists in choosing
the right strategy in DBC situations and is in my opinion suitable for publication in
BMC Gastroenterology.
Minor points:
1. Abbreviations are not always defined at the first appearance in the text (e.g.
CBD page 4 or PD page 6)
2. Although the authors clearly state that complications were classified and
graded according the consensus guidelines, it might be helpful for the reader if
the criteria for mild, moderate and severe pancreatitis would be shortly
described.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Sequential algorithm analysis to facilitate selective biliary access for difficult
biliary cannulation in ERCP: a prospective clinical study
Version:1Date:27 January 2014
Reviewer: Gernot Sellge
Reviewer's report:
The paper reports on a prospective case series of ERCPs using a sequential
protocol in situations with difficult biliary cannulation (DBC). The authors describe
an algorithm consisting of double guidewire cannulation followed by precut after
placement of a pancreatic stent in patients with unintentional pancreatic duct
cannulation and early precut fistulotomy in patients with DBC for other reasons.
DBC criteria were relatively strict (e.g. cannulation time > 5min) compared to
other studies. The procedure performed by a single experienced endoscopist
lead to successful cannulation in 136/140 patients and was overall save.
Although the study design did not compare different strategies, the case series
describes a safe and feasible step by step algorithm for DBC. The patient
numbers are sufficient, and the procedures and criteria are clearly described and
seem to be well controlled. The study may help other endoscopists in choosing
the right strategy in DBC situations and is in my opinion suitable for publication in
BMC Gastroenterology.
Minor points:
1. Abbreviations are not always defined at the first appearance in the text (e.g.
CBD page 4 or PD page 6)
2. Although the authors clearly state that complications were classified and
graded according the consensus guidelines, it might be helpful for the reader if
the criteria for mild, moderate and severe pancreatitis would be shortly
described.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
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