Title: Comparison of endoscopic retrograde cholangiopancreatography outcomes between cap-
fitted forward and side viewing endoscopes in patients with Billroth II anastomosis
Version: 3 Date: 08 Nov 2022
Reviewer's report:
This is a single-center retrospective observational study to compare ERCP outcomes between
CE group and SE group. This study is interesting. However, there are several concerns to be
mentioned in this manuscript.
Major comment:
1) Factors associated with ERCP-related complications including diameter of bile duct, usage
of antithrombotics and antibiotics should be included in Table1. Furthermore, the rate of
successful selective biliary cannulation, selective cannulation time, cannulation technique such
as guidewire-assisted cannulation, unintended pancreatic injection and pancreatic guidewire
insertion, and precut sphincterotomy should be included in Table2.
2) Comparison of ERCP outcomes between CE group and SE group in this form is unfair because
the several patient backgrounds such as EST only and EPBD are different between CE group
and SE group. Therefore, the authors should compare the ERCP outcomes between CE group
and SE group after matching patient backgrounds between the CE group and SE group.
3) Aggressive hydration is an effective for prophylaxis of PEP. The authors should describe
this point.
4) How did the authors decide to use cap-fitted forward viewing scope or side viewing scope?
The author’s strategy for selection of endoscope should be clarified in this study.
5) Although clinical ERCP outcomes between CE group and SE group were not significantly
different in this study because of small sample size of SE group, clinical ERCP outcomes seemed
to be better in SE group than in CE group. Therefore, if side-viewing scope can be inserted safely,
performing ERCP using side-viewing scope may be better in patients with B-2 anastomosis.
Side-viewing scope insertion through a large-diameter overtube after the placement of a large-
diameter overtube designed for colonoscopy into the afferent loop may help the side-viewing
insertion in patients with B-2 anastomosis. Tips of side-viewing insertion in patients with B-2
anastomosis should be discussed.
Minor comments:
1) Did the authors perform EPLBD for large or multiple stones?
2) The rates of inability to reach the major duodenal papilla in CE group and SE group should
be clarified.
3) Why did the authors exclude patients with Braun anastomosis?
4) Detail of forward-viewing and side-viewing endoscope should be described. (GIF-Q260J?
TJF-260V?)
5) Please add the tips of biliary cannulation using forward-viewing endoscope in patients with
B-2 anastomosis to be more practical.
Title: Comparison of endoscopic retrograde cholangiopancreatography outcomes between cap-
fitted forward and side viewing endoscopes in patients with Billroth II anastomosis
Version: 3 Date: 08 Nov 2022
Reviewer's report:
This is a single-center retrospective observational study to compare ERCP outcomes between
CE group and SE group. This study is interesting. However, there are several concerns to be
mentioned in this manuscript.
Major comment:
1) Factors associated with ERCP-related complications including diameter of bile duct, usage
of antithrombotics and antibiotics should be included in Table1. Furthermore, the rate of
successful selective biliary cannulation, selective cannulation time, cannulation technique such
as guidewire-assisted cannulation, unintended pancreatic injection and pancreatic guidewire
insertion, and precut sphincterotomy should be included in Table2.
2) Comparison of ERCP outcomes between CE group and SE group in this form is unfair because
the several patient backgrounds such as EST only and EPBD are different between CE group
and SE group. Therefore, the authors should compare the ERCP outcomes between CE group
and SE group after matching patient backgrounds between the CE group and SE group.
3) Aggressive hydration is an effective for prophylaxis of PEP. The authors should describe
this point.
4) How did the authors decide to use cap-fitted forward viewing scope or side viewing scope?
The author’s strategy for selection of endoscope should be clarified in this study.
5) Although clinical ERCP outcomes between CE group and SE group were not significantly
different in this study because of small sample size of SE group, clinical ERCP outcomes seemed
to be better in SE group than in CE group. Therefore, if side-viewing scope can be inserted safely,
performing ERCP using side-viewing scope may be better in patients with B-2 anastomosis.
Side-viewing scope insertion through a large-diameter overtube after the placement of a large-
diameter overtube designed for colonoscopy into the afferent loop may help the side-viewing
insertion in patients with B-2 anastomosis. Tips of side-viewing insertion in patients with B-2
anastomosis should be discussed.
Minor comments:
1) Did the authors perform EPLBD for large or multiple stones?
2) The rates of inability to reach the major duodenal papilla in CE group and SE group should
be clarified.
3) Why did the authors exclude patients with Braun anastomosis?
4) Detail of forward-viewing and side-viewing endoscope should be described. (GIF-Q260J?
TJF-260V?)
5) Please add the tips of biliary cannulation using forward-viewing endoscope in patients with
B-2 anastomosis to be more practical.
Please review this paper.
user
Title: Comparison of endoscopic retrograde cholangiopancreatography outcomes between cap-
fitted forward and side viewing endoscopes in patients with Billroth II anastomosis
Version: 3 Date: 08 Nov 2022
Reviewer's report:
This is a single-center retrospective observational study to compare ERCP outcomes between
CE group and SE group. This study is interesting. However, there are several concerns to be
mentioned in this manuscript.
Major comment:
1) Factors associated with ERCP-related complications including diameter of bile duct, usage
of antithrombotics and antibiotics should be included in Table1. Furthermore, the rate of
successful selective biliary cannulation, selective cannulation time, cannulation technique such
as guidewire-assisted cannulation, unintended pancreatic injection and pancreatic guidewire
insertion, and precut sphincterotomy should be included in Table2.
2) Comparison of ERCP outcomes between CE group and SE group in this form is unfair because
the several patient backgrounds such as EST only and EPBD are different between CE group
and SE group. Therefore, the authors should compare the ERCP outcomes between CE group
and SE group after matching patient backgrounds between the CE group and SE group.
3) Aggressive hydration is an effective for prophylaxis of PEP. The authors should describe
this point.
4) How did the authors decide to use cap-fitted forward viewing scope or side viewing scope?
The author’s strategy for selection of endoscope should be clarified in this study.
5) Although clinical ERCP outcomes between CE group and SE group were not significantly
different in this study because of small sample size of SE group, clinical ERCP outcomes seemed
to be better in SE group than in CE group. Therefore, if side-viewing scope can be inserted safely,
performing ERCP using side-viewing scope may be better in patients with B-2 anastomosis.
Side-viewing scope insertion through a large-diameter overtube after the placement of a large-
diameter overtube designed for colonoscopy into the afferent loop may help the side-viewing
insertion in patients with B-2 anastomosis. Tips of side-viewing insertion in patients with B-2
anastomosis should be discussed.
Minor comments:
1) Did the authors perform EPLBD for large or multiple stones?
2) The rates of inability to reach the major duodenal papilla in CE group and SE group should
be clarified.
3) Why did the authors exclude patients with Braun anastomosis?
4) Detail of forward-viewing and side-viewing endoscope should be described. (GIF-Q260J?
TJF-260V?)
5) Please add the tips of biliary cannulation using forward-viewing endoscope in patients with
B-2 anastomosis to be more practical.
assistant