Reviewer's report
Title:Predicting native papilla biliary cannulation success using a multinational
Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network
Version: 1Date:9 July 2013
Reviewer: lars aabakken
Reviewer's report:
This is an excellent piece of work eluciding the factors contributing to successful
ERCP.
I have the following minor comments:
- The issue of selection bias must be commented upon. While the control for
total/expected volumes is useful for selection within the doctors (probably), it is
highly likely that those volunteering to this network are not your average doctor.
Thus, the problematic situations of lower competence may not have been
properly addressed by a volunteer system. This may limit generalizability of the
findings.
- Some of the factors involved, e.g. case complexity, are based on issues related
to the entire procedure, while this is a cannulation- focused study. Better
gradings may be lacking, but it should be commented on that complex procedure
may not translate to complex cannulation per se.
- The issue of trainees is unclear to me – what does 100% involvement mean?
Involvement in 100% of cases, or cases done 100% by the trainee? If the latter is
the case, then no wonder the success was 100%, by circular definition… To be
clarified. Otherwise, the issue if trainee involvement is inherently difficult to
interpret, to the extent that it might be better avoided.
- A lot of the discussion is related to training and competence, - somewhat in the
outskirts of this study, may be shortened.
- Also, somewhat surprising, cannulation seems related to anything BUT
training-associated factors. This challenges current thinking on training, volumes
etc, but may be merely a result of the selection bias touched upon above.
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests
Reviewer's report
Title:Predicting native papilla biliary cannulation success using a multinational
Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network
Version: 1Date:9 July 2013
Reviewer: lars aabakken
Reviewer's report:
This is an excellent piece of work eluciding the factors contributing to successful
ERCP.
I have the following minor comments:
- The issue of selection bias must be commented upon. While the control for
total/expected volumes is useful for selection within the doctors (probably), it is
highly likely that those volunteering to this network are not your average doctor.
Thus, the problematic situations of lower competence may not have been
properly addressed by a volunteer system. This may limit generalizability of the
findings.
- Some of the factors involved, e.g. case complexity, are based on issues related
to the entire procedure, while this is a cannulation- focused study. Better
gradings may be lacking, but it should be commented on that complex procedure
may not translate to complex cannulation per se.
- The issue of trainees is unclear to me – what does 100% involvement mean?
Involvement in 100% of cases, or cases done 100% by the trainee? If the latter is
the case, then no wonder the success was 100%, by circular definition… To be
clarified. Otherwise, the issue if trainee involvement is inherently difficult to
interpret, to the extent that it might be better avoided.
- A lot of the discussion is related to training and competence, - somewhat in the
outskirts of this study, may be shortened.
- Also, somewhat surprising, cannulation seems related to anything BUT
training-associated factors. This challenges current thinking on training, volumes
etc, but may be merely a result of the selection bias touched upon above.
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Predicting native papilla biliary cannulation success using a multinational
Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network
Version: 1Date:9 July 2013
Reviewer: lars aabakken
Reviewer's report:
This is an excellent piece of work eluciding the factors contributing to successful
ERCP.
I have the following minor comments:
- The issue of selection bias must be commented upon. While the control for
total/expected volumes is useful for selection within the doctors (probably), it is
highly likely that those volunteering to this network are not your average doctor.
Thus, the problematic situations of lower competence may not have been
properly addressed by a volunteer system. This may limit generalizability of the
findings.
- Some of the factors involved, e.g. case complexity, are based on issues related
to the entire procedure, while this is a cannulation- focused study. Better
gradings may be lacking, but it should be commented on that complex procedure
may not translate to complex cannulation per se.
- The issue of trainees is unclear to me – what does 100% involvement mean?
Involvement in 100% of cases, or cases done 100% by the trainee? If the latter is
the case, then no wonder the success was 100%, by circular definition… To be
clarified. Otherwise, the issue if trainee involvement is inherently difficult to
interpret, to the extent that it might be better avoided.
- A lot of the discussion is related to training and competence, - somewhat in the
outskirts of this study, may be shortened.
- Also, somewhat surprising, cannulation seems related to anything BUT
training-associated factors. This challenges current thinking on training, volumes
etc, but may be merely a result of the selection bias touched upon above.
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests
assistant