Reviewer ’s report  
 
Title: Endoscopic ultrasound -assisted transmural chole cystoduodenostomy or 
cholecystogastrostomy as a bridge for per -oral cholecystoscopy therapy using double -flanged 
fully covered metal stent  
 
Version: 0 Date: 19 Oct 2015  
 
Reviewer: Ping-Hsin  Hsieh  
 
Reviewer's report:  
1. Regarding the inclusion criteria in your study method, please specify why you need to 
evaluate the function of gallbladder by fat meal test. Is there any evidence that the result of 
this test will influence the outcome of patients with gallbladder stone ? 
2. Please specify the definition of symptomatic gallbladder stone in your study.  
3. Since laparoscopic cholecystectomy is the gold standard of treatment for symptomatic 
gallbladder stone, this novel procedure should only be applied to those who are medi cally 
unfit or unwilling to receive laparoscopic cholecystectomy. Why you didn't place that in your 
inclusion criteria?  
4. Laparoscopic cholecystectomy in patients who ever received endoscopic or surgical 
cholecystogastrostomy may be quite difficult due to  regional fibrosis. That means this novel 
procedure may make further management quite complicated if gallbladder stone recurred. Do 
you have any idea about the recurrence rate of gallbladder stone in patients receiving 
gallbladder -preserving surgery?  
5. You also mentioned that for those who still have good gallbladder functions, gallbladder -
preserving cholecystolithotomy should be considered. Do you have any evidence on making 
this suggestion?  
6. Please cite some references about using Laparoscopic, transcu taneous, and endoscopic 
methods to perform cholecystolithotomy.  
7. I would suggest you to compare the outcome of there patients with other forms of 
gallbladder -preserving cholecystolithotomy and, most important, laparoscopic 
cholecystectomy.  
8. About your conclusion, I agree it seems to be a safe method to remove the stones in 
gallbladder, however, you should provide more data, such as procedure time, to prove it is a 
simple procedure.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of wr itten English  
Please indicate the quality of language in the manuscript:  
 
Needs some langu age corrections before being published  
 
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 financially from the publication of this 
manuscript, either now or in the  future?  
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents rela ting 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 that 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 acc epted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Acce ss Creative Commons 
CC-BY license ( http://creativecommon s.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included 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 ultrasound -assisted transmural chole cystoduodenostomy or 
cholecystogastrostomy as a bridge for per -oral cholecystoscopy therapy using double -flanged 
fully covered metal stent  
 
Version: 0 Date: 19 Oct 2015  
 
Reviewer: Ping-Hsin  Hsieh  
 
Reviewer's report:  
1. Regarding the inclusion criteria in your study method, please specify why you need to 
evaluate the function of gallbladder by fat meal test. Is there any evidence that the result of 
this test will influence the outcome of patients with gallbladder stone ? 
2. Please specify the definition of symptomatic gallbladder stone in your study.  
3. Since laparoscopic cholecystectomy is the gold standard of treatment for symptomatic 
gallbladder stone, this novel procedure should only be applied to those who are medi cally 
unfit or unwilling to receive laparoscopic cholecystectomy. Why you didn't place that in your 
inclusion criteria?  
4. Laparoscopic cholecystectomy in patients who ever received endoscopic or surgical 
cholecystogastrostomy may be quite difficult due to  regional fibrosis. That means this novel 
procedure may make further management quite complicated if gallbladder stone recurred. Do 
you have any idea about the recurrence rate of gallbladder stone in patients receiving 
gallbladder -preserving surgery?  
5. You also mentioned that for those who still have good gallbladder functions, gallbladder -
preserving cholecystolithotomy should be considered. Do you have any evidence on making 
this suggestion?  
6. Please cite some references about using Laparoscopic, transcu taneous, and endoscopic 
methods to perform cholecystolithotomy.  
7. I would suggest you to compare the outcome of there patients with other forms of 
gallbladder -preserving cholecystolithotomy and, most important, laparoscopic 
cholecystectomy.  
8. About your conclusion, I agree it seems to be a safe method to remove the stones in 
gallbladder, however, you should provide more data, such as procedure time, to prove it is a 
simple procedure.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of wr itten English  
Please indicate the quality of language in the manuscript:  
 
Needs some langu age corrections before being published  
 
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 financially from the publication of this 
manuscript, either now or in the  future?  
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents rela ting 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 that 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 acc epted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Acce ss Creative Commons 
CC-BY license ( http://creativecommon s.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included 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 ultrasound -assisted transmural chole cystoduodenostomy or 
cholecystogastrostomy as a bridge for per -oral cholecystoscopy therapy using double -flanged 
fully covered metal stent  
 
Version: 0 Date: 19 Oct 2015  
 
Reviewer: Ping-Hsin  Hsieh  
 
Reviewer's report:  
1. Regarding the inclusion criteria in your study method, please specify why you need to 
evaluate the function of gallbladder by fat meal test. Is there any evidence that the result of 
this test will influence the outcome of patients with gallbladder stone ? 
2. Please specify the definition of symptomatic gallbladder stone in your study.  
3. Since laparoscopic cholecystectomy is the gold standard of treatment for symptomatic 
gallbladder stone, this novel procedure should only be applied to those who are medi cally 
unfit or unwilling to receive laparoscopic cholecystectomy. Why you didn't place that in your 
inclusion criteria?  
4. Laparoscopic cholecystectomy in patients who ever received endoscopic or surgical 
cholecystogastrostomy may be quite difficult due to  regional fibrosis. That means this novel 
procedure may make further management quite complicated if gallbladder stone recurred. Do 
you have any idea about the recurrence rate of gallbladder stone in patients receiving 
gallbladder -preserving surgery?  
5. You also mentioned that for those who still have good gallbladder functions, gallbladder -
preserving cholecystolithotomy should be considered. Do you have any evidence on making 
this suggestion?  
6. Please cite some references about using Laparoscopic, transcu taneous, and endoscopic 
methods to perform cholecystolithotomy.  
7. I would suggest you to compare the outcome of there patients with other forms of 
gallbladder -preserving cholecystolithotomy and, most important, laparoscopic 
cholecystectomy.  
8. About your conclusion, I agree it seems to be a safe method to remove the stones in 
gallbladder, however, you should provide more data, such as procedure time, to prove it is a 
simple procedure.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of wr itten English  
Please indicate the quality of language in the manuscript:  
 
Needs some langu age corrections before being published  
 
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 financially from the publication of this 
manuscript, either now or in the  future?  
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents rela ting 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 that 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 acc epted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Acce ss Creative Commons 
CC-BY license ( http://creativecommon s.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
I agree to the open peer review policy of the journal  
assistant