Title: Study of factors influencing the insertion failure of single balloon enterostomy-assisted
ERC P treatment after bilioenteric Rou-en-Y anastomosis
Version: 3 Date: 21 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The introduction mentions the challenges associated with "intestinal lumen angulation and
stricture due to intra-abdominal adhesions," which is a critical point. However, it would be
helpful to briefly discuss the existing literature on post-Roux-en-Y anatomy and how these
factors specifically impair ERCP insertion. Adding a more in-depth review of related studies
would help to establish the background for why this particular study is important and how it
fills a gap in current knowledge.
-The mention of a “digestive tract structure schema” to guide endoscopic progress is intriguing,
but it is not explained in detail. Was this schema a preoperative imaging study (e.g., CT scan or
endoscopic ultrasound)? Or was it a schematic drawing based on prior knowledge? Providing
more information here would clarify its role in the planning and execution of the procedure.
-The patient cohort is described well in terms of the number of patients and the indications
for ERCP (e.g., intrahepatic stones, anastomotic strictures). However, there is no mention of
whether these patients had any other comorbidities that might influence outcomes (e.g., diabetes,
obesity, or previous ERCP complications). Including these variables in the cohort description
could help in identifying other possible risk factors for insertion failure.
-X-ray imaging is frequently mentioned as a tool to guide the progress of enteroscopy, which
is valuable. However, it would be helpful to elaborate on how X-ray guidance was employed
—was it fluoroscopy? How did it specifically aid in overcoming challenges related to altered
anatomy? Describing this in more detail would give readers better insight into how technology
was integrated into the procedure.
-The recommendations for surgical modifications to improve ERCP outcomes are sound, but
they could be expanded. For example, while the authors suggest shortening the afferent loop and
avoiding U-shaped folding, there is limited discussion of how these changes affect the overall
surgical process or long-term patient outcomes. How do these modifications impact the recovery
and function of the gastrointestinal tract, particularly in patients who may require additional
interventions like PTCD or open surgery?
Title: Study of factors influencing the insertion failure of single balloon enterostomy-assisted
ERC P treatment after bilioenteric Rou-en-Y anastomosis
Version: 3 Date: 21 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The introduction mentions the challenges associated with "intestinal lumen angulation and
stricture due to intra-abdominal adhesions," which is a critical point. However, it would be
helpful to briefly discuss the existing literature on post-Roux-en-Y anatomy and how these
factors specifically impair ERCP insertion. Adding a more in-depth review of related studies
would help to establish the background for why this particular study is important and how it
fills a gap in current knowledge.
-The mention of a “digestive tract structure schema” to guide endoscopic progress is intriguing,
but it is not explained in detail. Was this schema a preoperative imaging study (e.g., CT scan or
endoscopic ultrasound)? Or was it a schematic drawing based on prior knowledge? Providing
more information here would clarify its role in the planning and execution of the procedure.
-The patient cohort is described well in terms of the number of patients and the indications
for ERCP (e.g., intrahepatic stones, anastomotic strictures). However, there is no mention of
whether these patients had any other comorbidities that might influence outcomes (e.g., diabetes,
obesity, or previous ERCP complications). Including these variables in the cohort description
could help in identifying other possible risk factors for insertion failure.
-X-ray imaging is frequently mentioned as a tool to guide the progress of enteroscopy, which
is valuable. However, it would be helpful to elaborate on how X-ray guidance was employed
—was it fluoroscopy? How did it specifically aid in overcoming challenges related to altered
anatomy? Describing this in more detail would give readers better insight into how technology
was integrated into the procedure.
-The recommendations for surgical modifications to improve ERCP outcomes are sound, but
they could be expanded. For example, while the authors suggest shortening the afferent loop and
avoiding U-shaped folding, there is limited discussion of how these changes affect the overall
surgical process or long-term patient outcomes. How do these modifications impact the recovery
and function of the gastrointestinal tract, particularly in patients who may require additional
interventions like PTCD or open surgery?
Please review this paper.
user
Title: Study of factors influencing the insertion failure of single balloon enterostomy-assisted
ERC P treatment after bilioenteric Rou-en-Y anastomosis
Version: 3 Date: 21 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The introduction mentions the challenges associated with "intestinal lumen angulation and
stricture due to intra-abdominal adhesions," which is a critical point. However, it would be
helpful to briefly discuss the existing literature on post-Roux-en-Y anatomy and how these
factors specifically impair ERCP insertion. Adding a more in-depth review of related studies
would help to establish the background for why this particular study is important and how it
fills a gap in current knowledge.
-The mention of a “digestive tract structure schema” to guide endoscopic progress is intriguing,
but it is not explained in detail. Was this schema a preoperative imaging study (e.g., CT scan or
endoscopic ultrasound)? Or was it a schematic drawing based on prior knowledge? Providing
more information here would clarify its role in the planning and execution of the procedure.
-The patient cohort is described well in terms of the number of patients and the indications
for ERCP (e.g., intrahepatic stones, anastomotic strictures). However, there is no mention of
whether these patients had any other comorbidities that might influence outcomes (e.g., diabetes,
obesity, or previous ERCP complications). Including these variables in the cohort description
could help in identifying other possible risk factors for insertion failure.
-X-ray imaging is frequently mentioned as a tool to guide the progress of enteroscopy, which
is valuable. However, it would be helpful to elaborate on how X-ray guidance was employed
—was it fluoroscopy? How did it specifically aid in overcoming challenges related to altered
anatomy? Describing this in more detail would give readers better insight into how technology
was integrated into the procedure.
-The recommendations for surgical modifications to improve ERCP outcomes are sound, but
they could be expanded. For example, while the authors suggest shortening the afferent loop and
avoiding U-shaped folding, there is limited discussion of how these changes affect the overall
surgical process or long-term patient outcomes. How do these modifications impact the recovery
and function of the gastrointestinal tract, particularly in patients who may require additional
interventions like PTCD or open surgery?
assistant