Title: Influence of a novel classification of the papilla of Vater on the outcome of needle-knife
fistulotomy for biliary cannulation
Version: 1 Date: 11 Jan 2021
Reviewer's report:
This article attempts to built upon pre-existing morphological classifications of the major
ampulla and assess the impact on ampullary morphology on rescue needle knife fistulotomy.
The classification is certainly more expansive but to assist in its usability, a couple of core points
need to be addressed:
1. clarifying the terminology "oral protrusion". This is confusing. Presumably this is referring
to the superior aspect of the intra-duodenal portion of the ampullary complex and its 'protrusion'
into the duodenal lumen. It could also refer to the location and orientation of the orifice. It also
is not mutually exclusive for Type IIIa and IIIb ampullas, of which the classification makes no
mention of their 'oral protrusion'. I suggest revising this key term.
2. reporting on the distribution of each ampullary type in the original classification of 550 still
images, in particular, Type IV. If there are multiple morphologies within Type IV, this would
weaken the exclusivity of 6 other categories.
3. explain why it is important to differentiate between Type IIa and IIb ampullas. This distinction
is difficult for ERCPists to classify with only 59 and 66% (respectively) being able to classify
correctly. The discussion points to an "intuitive(ly) belief" that the two ampullas will behave
differently, but this is not expanded upon.
The article is otherwise comprehensive and provides a good discussion of its merits compared
to prior classification attempts. Whilst my personal belief is that the proposed classification
remains too complicated for everyday clinical use, the article contributes to the growing
discussion and interest in ampullary classification.
Title: Influence of a novel classification of the papilla of Vater on the outcome of needle-knife
fistulotomy for biliary cannulation
Version: 1 Date: 11 Jan 2021
Reviewer's report:
This article attempts to built upon pre-existing morphological classifications of the major
ampulla and assess the impact on ampullary morphology on rescue needle knife fistulotomy.
The classification is certainly more expansive but to assist in its usability, a couple of core points
need to be addressed:
1. clarifying the terminology "oral protrusion". This is confusing. Presumably this is referring
to the superior aspect of the intra-duodenal portion of the ampullary complex and its 'protrusion'
into the duodenal lumen. It could also refer to the location and orientation of the orifice. It also
is not mutually exclusive for Type IIIa and IIIb ampullas, of which the classification makes no
mention of their 'oral protrusion'. I suggest revising this key term.
2. reporting on the distribution of each ampullary type in the original classification of 550 still
images, in particular, Type IV. If there are multiple morphologies within Type IV, this would
weaken the exclusivity of 6 other categories.
3. explain why it is important to differentiate between Type IIa and IIb ampullas. This distinction
is difficult for ERCPists to classify with only 59 and 66% (respectively) being able to classify
correctly. The discussion points to an "intuitive(ly) belief" that the two ampullas will behave
differently, but this is not expanded upon.
The article is otherwise comprehensive and provides a good discussion of its merits compared
to prior classification attempts. Whilst my personal belief is that the proposed classification
remains too complicated for everyday clinical use, the article contributes to the growing
discussion and interest in ampullary classification.
Please review this paper.
user
Title: Influence of a novel classification of the papilla of Vater on the outcome of needle-knife
fistulotomy for biliary cannulation
Version: 1 Date: 11 Jan 2021
Reviewer's report:
This article attempts to built upon pre-existing morphological classifications of the major
ampulla and assess the impact on ampullary morphology on rescue needle knife fistulotomy.
The classification is certainly more expansive but to assist in its usability, a couple of core points
need to be addressed:
1. clarifying the terminology "oral protrusion". This is confusing. Presumably this is referring
to the superior aspect of the intra-duodenal portion of the ampullary complex and its 'protrusion'
into the duodenal lumen. It could also refer to the location and orientation of the orifice. It also
is not mutually exclusive for Type IIIa and IIIb ampullas, of which the classification makes no
mention of their 'oral protrusion'. I suggest revising this key term.
2. reporting on the distribution of each ampullary type in the original classification of 550 still
images, in particular, Type IV. If there are multiple morphologies within Type IV, this would
weaken the exclusivity of 6 other categories.
3. explain why it is important to differentiate between Type IIa and IIb ampullas. This distinction
is difficult for ERCPists to classify with only 59 and 66% (respectively) being able to classify
correctly. The discussion points to an "intuitive(ly) belief" that the two ampullas will behave
differently, but this is not expanded upon.
The article is otherwise comprehensive and provides a good discussion of its merits compared
to prior classification attempts. Whilst my personal belief is that the proposed classification
remains too complicated for everyday clinical use, the article contributes to the growing
discussion and interest in ampullary classification.
assistant