Reviewer's report
Title:Endoscopic papillary large balloon dilation alone without sphincterotomy for
the treatment of large common bile duct stones
Version: 1Date:23 April 2011
Reviewer: Peter V Draganov
Reviewer's report:
The authors retrospectively review their experience with the use of large balloon
dilation of native papilla for extraction of biliary stones. This is a relatively new
technique with very little data available in the literature. From that perspective
this manuscript brings an important contribution. The paper is well written and
easy to follow. The study suffers from the usual shortcomings associated with
retrospective research. Nevertheless the findings will be of interest to the
practicing Gastroenterologist.
Specific remarks:
1) In the discussion please acknowledge the limitations of this study including
a. Retrospective design
b. No predetermined criteria existed on who will be treated wit large balloon
dilation versus standard sphincterotomy (Patient selection bias)
c. There was no predetermined protocol on the exact size of the balloon and the
time for inflation (Intervention/exposure bias)
d. Complications were assessed retrospectively and retrospective studies are
notorious for under representing complications (Measurement bias)
e. No standard follow-up was applied (Measurement bias). The stone recurrence
rate in the patients who were followed up was quite high (25/172 patients) which
raises concerns whether stone clearance was complete on the initial ERCP.
f. Significant number of patients were lost to follow-up (measurement bias)
2) In order to be able to discuss the issues described under #1 the discussion
should be shortened significantly.
3) Please shorten the result section. Most of the data in the first paragraph of the
result section are already incorporated or can be incorporated in Table 1.
4) Table 2: Please use the American Society for Anesthesia classification (ASA
class) to grade patient comorbidities.
5) Please use the updated ASGE consensus statement for defining and grading
complications instead of the dated reference # 17.
Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse
events: report of an ASGE workshop. Gastrointest Endosc 2010;71:446-54
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:Endoscopic papillary large balloon dilation alone without sphincterotomy for
the treatment of large common bile duct stones
Version: 1Date:23 April 2011
Reviewer: Peter V Draganov
Reviewer's report:
The authors retrospectively review their experience with the use of large balloon
dilation of native papilla for extraction of biliary stones. This is a relatively new
technique with very little data available in the literature. From that perspective
this manuscript brings an important contribution. The paper is well written and
easy to follow. The study suffers from the usual shortcomings associated with
retrospective research. Nevertheless the findings will be of interest to the
practicing Gastroenterologist.
Specific remarks:
1) In the discussion please acknowledge the limitations of this study including
a. Retrospective design
b. No predetermined criteria existed on who will be treated wit large balloon
dilation versus standard sphincterotomy (Patient selection bias)
c. There was no predetermined protocol on the exact size of the balloon and the
time for inflation (Intervention/exposure bias)
d. Complications were assessed retrospectively and retrospective studies are
notorious for under representing complications (Measurement bias)
e. No standard follow-up was applied (Measurement bias). The stone recurrence
rate in the patients who were followed up was quite high (25/172 patients) which
raises concerns whether stone clearance was complete on the initial ERCP.
f. Significant number of patients were lost to follow-up (measurement bias)
2) In order to be able to discuss the issues described under #1 the discussion
should be shortened significantly.
3) Please shorten the result section. Most of the data in the first paragraph of the
result section are already incorporated or can be incorporated in Table 1.
4) Table 2: Please use the American Society for Anesthesia classification (ASA
class) to grade patient comorbidities.
5) Please use the updated ASGE consensus statement for defining and grading
complications instead of the dated reference # 17.
Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse
events: report of an ASGE workshop. Gastrointest Endosc 2010;71:446-54
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:Endoscopic papillary large balloon dilation alone without sphincterotomy for
the treatment of large common bile duct stones
Version: 1Date:23 April 2011
Reviewer: Peter V Draganov
Reviewer's report:
The authors retrospectively review their experience with the use of large balloon
dilation of native papilla for extraction of biliary stones. This is a relatively new
technique with very little data available in the literature. From that perspective
this manuscript brings an important contribution. The paper is well written and
easy to follow. The study suffers from the usual shortcomings associated with
retrospective research. Nevertheless the findings will be of interest to the
practicing Gastroenterologist.
Specific remarks:
1) In the discussion please acknowledge the limitations of this study including
a. Retrospective design
b. No predetermined criteria existed on who will be treated wit large balloon
dilation versus standard sphincterotomy (Patient selection bias)
c. There was no predetermined protocol on the exact size of the balloon and the
time for inflation (Intervention/exposure bias)
d. Complications were assessed retrospectively and retrospective studies are
notorious for under representing complications (Measurement bias)
e. No standard follow-up was applied (Measurement bias). The stone recurrence
rate in the patients who were followed up was quite high (25/172 patients) which
raises concerns whether stone clearance was complete on the initial ERCP.
f. Significant number of patients were lost to follow-up (measurement bias)
2) In order to be able to discuss the issues described under #1 the discussion
should be shortened significantly.
3) Please shorten the result section. Most of the data in the first paragraph of the
result section are already incorporated or can be incorporated in Table 1.
4) Table 2: Please use the American Society for Anesthesia classification (ASA
class) to grade patient comorbidities.
5) Please use the updated ASGE consensus statement for defining and grading
complications instead of the dated reference # 17.
Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse
events: report of an ASGE workshop. Gastrointest Endosc 2010;71:446-54
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'
assistant