Risk Factors of Duodenobiliary Reflux-Related Dysfunction of Covered Biliary Metal Stents after Treatment of Duodenal Stricture in Patients with Malignant Biliary and Duodenal Obstruction

Round 1

Reviewer 1 Report

In this manuscript the authors reported the results on the risk factors of duodenobiliary reflux-related covered biliary metal stents dysfunction after treatment of duodenal stricture for malignant biliary and duodenal obstruction. They described a good number of clinical cases with interesting results.

Followings are more concrete comments:

1) The duodenobiliary reflux-related covered biliary metal stents dysfunction after treatment of duodenal stricture for malignantbiliary and duodenal obstruction is a major problem. 2) The topic is relevant because biliary duodenal reflux occurs frequently 3) The work adds a useful experience on the topic 4) The work is methodologically correct 5) The conclusions are consistent and answer the main question asked 6) References are appropriate  

Author Response

Thanks for your kindly recommendation.

Reviewer 2 Report

Manuscript ID: curroncol-1378561

General comments:

Biliary tumors are generally unresectable, and the majority of patients with malignant biliary obstruction have a poor quality of life due to chronic cholestatic jaundice, pruritus, and malabsorption, and have a poor overall prognosis. Endoscopic stent insertion has become an accepted standard treatment for these patients. Several previous studies have demonstrated that self-expandable metal stents (SEMSs) remain patent and have fewer complications in comparison with plastic stents. However, recurrent biliary obstruction after their placement may occur. The presented study represents an attempt to select the risk factors associated with the aforementioned stents dysfunction. The subject of the manuscript is interesting, although several issues should be addressed.

Specific comments:

The title of the article is unclear and I would recommend modifying it, eg.

Risk factors of duodenobiliary reflux-related dysfunction of covered metal biliary stents after treatment of duodenal stricture in patients with malignant biliary and duodenal obstruction.

Line 81- „…liver function test…” should be changed to liver function tests

Line 82 – „The exclusion criteria were patients with…” change to the exclusion criteria included RBO complications…

Line 92- „…methods of duodenal obstruction…” should be rather changed to treatment methods of duodenal obstruction

Line 116 a determiner is missing, change to The clinical success

Table 1 a hyphen is missing, change to Pre-procedure and Post-procedure

Table 2 explain also GOOSS abbreviation

All Tables- abbreviations should be explained and presented in the alphabetical order

Line 221 a determiner is missing, change to The contrast medium

Line 225 and 226 a determiner is missing, change to with the involvement, without the involvement

Line 238 I would recommend modifying the sentence to avoid repetition of the word obstruction, eg as follows:

…recurrent biliary obstruction did not differ significantly according to the original location of the duodenal obstacle. However, in this study, all the recurrent biliary obstructions which occurred in patients with the original duodenal lesions below the papilla of Vater were due to non-tumor- related reasons, which revealed that DBR-related stent dysfunction still plays a significant role in RBO in duodenal obstruction below the papilla of Vater.

Line 240 a hyphen is missing, change to non-tumor-related reasons

My conclusion: Minor revision is required.

Author Response

Thanks for your kindly recommendation.

We will revise the manuscript as your suggestion  

Reviewer 3 Report

Well prepared manuscript. Retrospective cohort analysis but data is sound and clinically relevant. Interesting article for a variety of different specialists - gastroenterologists, surgical and medical oncologists, HPB and GI surgeons, etc.

Author Response

Thanks for your kindly recommendation.