Title: Endoscopic sphincterotomy and endoscopic biliary stenting do not affect the sensitivity
of transpapillary forceps biopsy for the diagnosis of bile duct adenocarcinoma
Version: 1 Date: 08 May 2022
Reviewer's report:
Dear authors,
I congratulate you for your idea and your great work!
I have few suggestions and questions
line 11: I would suggest using post-ERCP pancreatitis (PEP) instead of ERCP-induced
pancreatitis (the same as you use in line 187)
line 60 This is not clear to me.
Do you define EST group, only if it EST was done in previous ERCP session? (this is my
understanding as you state later in the text  (line 98) that all EST’s were undertaken in other
institutions)
As opposed to those patients without EST?
But were there patients that underwent EST during the same ERCP and just prior to TB (in your
institution)? I would expect some patients undergoing EST just before TB, especially as this
was retrospective study and in clinical scenarios some patients from first to second reevaluation/
ERCP become jaundiced and need stenting and therefore EST in most cases
line 72: I would suggest being more precise concerning time limits specially weeks; as bleeding
let’s say eight weeks after the procedure with the drop in Hb level I’d say is quite likely to be
for other reasons
line 188 - I suggest to rewrite  and be more precise  on risk factors for PEP if you point that TB
after EST is safer and easier  (multiple cannulation procedures? you mean difficult cannulation,
multiple insertions before achieving deep biliary cannulation, different cannulation techniques
used?)
line 150 (table) EST and EBS often go together so if possible it would be great to have this
additional analysis
As for example it does not make much sense that patents that undergo TB without previous EBS
have much more PEP. Was this maybe because those without EBS actually did not undergo
EST, so therefore they were more prone to PEP as TB was done without EST?
Maybe additional analysis would be useful or at least a comment in discussion
I fell that that PEP incidence is significantly higher in patient undergoing TB without EST needs
to be stressed more in discussion/conclusion sections - I feel this very important information;
I personally would never do TB without previously doing EST (of course if EST is not
contraindicated)
Title: Endoscopic sphincterotomy and endoscopic biliary stenting do not affect the sensitivity
of transpapillary forceps biopsy for the diagnosis of bile duct adenocarcinoma
Version: 1 Date: 08 May 2022
Reviewer's report:
Dear authors,
I congratulate you for your idea and your great work!
I have few suggestions and questions
line 11: I would suggest using post-ERCP pancreatitis (PEP) instead of ERCP-induced
pancreatitis (the same as you use in line 187)
line 60 This is not clear to me.
Do you define EST group, only if it EST was done in previous ERCP session? (this is my
understanding as you state later in the text  (line 98) that all EST’s were undertaken in other
institutions)
As opposed to those patients without EST?
But were there patients that underwent EST during the same ERCP and just prior to TB (in your
institution)? I would expect some patients undergoing EST just before TB, especially as this
was retrospective study and in clinical scenarios some patients from first to second reevaluation/
ERCP become jaundiced and need stenting and therefore EST in most cases
line 72: I would suggest being more precise concerning time limits specially weeks; as bleeding
let’s say eight weeks after the procedure with the drop in Hb level I’d say is quite likely to be
for other reasons
line 188 - I suggest to rewrite  and be more precise  on risk factors for PEP if you point that TB
after EST is safer and easier  (multiple cannulation procedures? you mean difficult cannulation,
multiple insertions before achieving deep biliary cannulation, different cannulation techniques
used?)
line 150 (table) EST and EBS often go together so if possible it would be great to have this
additional analysis
As for example it does not make much sense that patents that undergo TB without previous EBS
have much more PEP. Was this maybe because those without EBS actually did not undergo
EST, so therefore they were more prone to PEP as TB was done without EST?
Maybe additional analysis would be useful or at least a comment in discussion
I fell that that PEP incidence is significantly higher in patient undergoing TB without EST needs
to be stressed more in discussion/conclusion sections - I feel this very important information;
I personally would never do TB without previously doing EST (of course if EST is not
contraindicated)
Please review this paper.
user
Title: Endoscopic sphincterotomy and endoscopic biliary stenting do not affect the sensitivity
of transpapillary forceps biopsy for the diagnosis of bile duct adenocarcinoma
Version: 1 Date: 08 May 2022
Reviewer's report:
Dear authors,
I congratulate you for your idea and your great work!
I have few suggestions and questions
line 11: I would suggest using post-ERCP pancreatitis (PEP) instead of ERCP-induced
pancreatitis (the same as you use in line 187)
line 60 This is not clear to me.
Do you define EST group, only if it EST was done in previous ERCP session? (this is my
understanding as you state later in the text  (line 98) that all EST’s were undertaken in other
institutions)
As opposed to those patients without EST?
But were there patients that underwent EST during the same ERCP and just prior to TB (in your
institution)? I would expect some patients undergoing EST just before TB, especially as this
was retrospective study and in clinical scenarios some patients from first to second reevaluation/
ERCP become jaundiced and need stenting and therefore EST in most cases
line 72: I would suggest being more precise concerning time limits specially weeks; as bleeding
let’s say eight weeks after the procedure with the drop in Hb level I’d say is quite likely to be
for other reasons
line 188 - I suggest to rewrite  and be more precise  on risk factors for PEP if you point that TB
after EST is safer and easier  (multiple cannulation procedures? you mean difficult cannulation,
multiple insertions before achieving deep biliary cannulation, different cannulation techniques
used?)
line 150 (table) EST and EBS often go together so if possible it would be great to have this
additional analysis
As for example it does not make much sense that patents that undergo TB without previous EBS
have much more PEP. Was this maybe because those without EBS actually did not undergo
EST, so therefore they were more prone to PEP as TB was done without EST?
Maybe additional analysis would be useful or at least a comment in discussion
I fell that that PEP incidence is significantly higher in patient undergoing TB without EST needs
to be stressed more in discussion/conclusion sections - I feel this very important information;
I personally would never do TB without previously doing EST (of course if EST is not
contraindicated)
assistant