Review for 10.1186/s12876-019-0977-1 (2019)

Reviewer ’s report  
 
Title: Endosc opic transpapillary drainage in disconnected pancreatic duct syndrome after acute  
pancreatitis and trauma: Long -term outcomes in 31 patients  
 
Version: 0 Date: 08 Dec 2018  
 
Reviewer: Raj Shah  
 
Reviewer's report:  
 
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The authors present a difficult and complex patient population. Efforts to improve outcomes in 
these patients with DPDS are often extensive with difficult result s. However, I am unsure that 
the authors present a compelling thesis to support the transpapillary stenting technique alone 
especially if a co -existing PFC is present that even if small can be a window for transmural 
drainage to provide, indirectly, draina ge of the 'disconnected' aspect of the pancreas. See below 
re: specific suggestions and questions:  
 
31 pt with DPDS. What was the denominator of pts during this time period that had ANP or abd 
trauma -related pancreatitis to give us an idea of incidence?  
 
What is the baseline average volume of each of the 4 ERCP doctors?  
 
Were patients from two centers or more?  
 
Nearly half of patients had PFC - was transmural drainage considered in those pts and if not 
why?  
 
When you state "The stent was inserted with its proximal end at the site of disruption" was 
'disruption' where there was complete cut -off of the duct and/or extravasation of contrast?  
 
Did any stents bridge the level of obstruction?  
 
Only 55% had clinical success and 8 pts required surgery. I wonder if combining transmural and 
percutaneous drainage may have improved the clinical success percentage. Please comment on 
this potential in the discussion.  
 
Authors bring up an interesting poi nt about atrophy developing in 10 pts. How many of the 10 
had PJ surgery? Did these pts have pain resolution?  
 
In discussion instead of saying 'proximal' pancreas and 'distal' pancreas, describe anatomical 
aspects of the pancreas to avoid confusion.  
 
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 the 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 written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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