Reviewer ’s report  
Title: Endoscopic Retrograde Cholangiopancreatography in the El derly: Results of a 
Retrospective Study and a Geriatricians' Point of View  
 
Version: 0 Date: 24 Dec 2017  
 
Reviewer: Amy Tyberg  
 
Reviewer's report:  
This is an excellent review evaluating the safety of ERCP in the elderly population.  
A few comments:  
1. The autho rs list the total number of complications between the two groups, but it would be 
interesting to know if certain complications were higher in the elderly group such as 
bleeding (given a higher percentage are likely on anti -coagulation), aspiration, cardiac  
abnormalities. Also, it would be helpful to know the breakdown of what complications 
occurred.  
2. The authors list 27 failures - 22 failed cannulation, 2 bradycardia, 1 perforation. What were 
the other 2?  
3. The authors state all patients were done unde r moderate sedation - did no patients require 
general anesthesia? Were patients who needed general anesthesia excluded?  
4. None of the patients in this series had malignant obstruction as the indication for ERCP -- 
were patients with cancer excluded? It s eems to me that a high percentage of older patients 
requiring ERCP are due to malignancy and it would be useful to know if the safety profile is 
as good in those patients since they tend to be longer and more complex ERCPs.  
5. Why did fewer patients in the elderly group have sphincterotomy? Is this because a higher 
percentage were on anti -coagulation? Could that be a factor in the lack of difference in 
complication rates between the gorups?  
6. This discussion is a bit long - I think it could be condensed a bit.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the a uthors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to t he authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, funding, or salary  from an  
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publicatio n of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the au thors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be incl uded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
Title: Endoscopic Retrograde Cholangiopancreatography in the El derly: Results of a 
Retrospective Study and a Geriatricians' Point of View  
 
Version: 0 Date: 24 Dec 2017  
 
Reviewer: Amy Tyberg  
 
Reviewer's report:  
This is an excellent review evaluating the safety of ERCP in the elderly population.  
A few comments:  
1. The autho rs list the total number of complications between the two groups, but it would be 
interesting to know if certain complications were higher in the elderly group such as 
bleeding (given a higher percentage are likely on anti -coagulation), aspiration, cardiac  
abnormalities. Also, it would be helpful to know the breakdown of what complications 
occurred.  
2. The authors list 27 failures - 22 failed cannulation, 2 bradycardia, 1 perforation. What were 
the other 2?  
3. The authors state all patients were done unde r moderate sedation - did no patients require 
general anesthesia? Were patients who needed general anesthesia excluded?  
4. None of the patients in this series had malignant obstruction as the indication for ERCP -- 
were patients with cancer excluded? It s eems to me that a high percentage of older patients 
requiring ERCP are due to malignancy and it would be useful to know if the safety profile is 
as good in those patients since they tend to be longer and more complex ERCPs.  
5. Why did fewer patients in the elderly group have sphincterotomy? Is this because a higher 
percentage were on anti -coagulation? Could that be a factor in the lack of difference in 
complication rates between the gorups?  
6. This discussion is a bit long - I think it could be condensed a bit.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the a uthors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to t he authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, funding, or salary  from an  
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publicatio n of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the au thors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be incl uded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
Title: Endoscopic Retrograde Cholangiopancreatography in the El derly: Results of a 
Retrospective Study and a Geriatricians' Point of View  
 
Version: 0 Date: 24 Dec 2017  
 
Reviewer: Amy Tyberg  
 
Reviewer's report:  
This is an excellent review evaluating the safety of ERCP in the elderly population.  
A few comments:  
1. The autho rs list the total number of complications between the two groups, but it would be 
interesting to know if certain complications were higher in the elderly group such as 
bleeding (given a higher percentage are likely on anti -coagulation), aspiration, cardiac  
abnormalities. Also, it would be helpful to know the breakdown of what complications 
occurred.  
2. The authors list 27 failures - 22 failed cannulation, 2 bradycardia, 1 perforation. What were 
the other 2?  
3. The authors state all patients were done unde r moderate sedation - did no patients require 
general anesthesia? Were patients who needed general anesthesia excluded?  
4. None of the patients in this series had malignant obstruction as the indication for ERCP -- 
were patients with cancer excluded? It s eems to me that a high percentage of older patients 
requiring ERCP are due to malignancy and it would be useful to know if the safety profile is 
as good in those patients since they tend to be longer and more complex ERCPs.  
5. Why did fewer patients in the elderly group have sphincterotomy? Is this because a higher 
percentage were on anti -coagulation? Could that be a factor in the lack of difference in 
complication rates between the gorups?  
6. This discussion is a bit long - I think it could be condensed a bit.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the a uthors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to t he authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, funding, or salary  from an  
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publicatio n of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the au thors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be incl uded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant