Review for 10.1186/s12876-018-0764-4 (2018)

Reviewer ’s report  
Title: Endoscopic Retrograde Cholangiopancreatography in the El derly: Results of a 
Retrospective Study and a Geriatricians' Point of View  
 
Version: 0 Date: 24 Dec 2017  
 
Reviewer: Amy Tyberg  
 
Reviewer's report:  
This is an excellent review evaluating the safety of ERCP in the elderly population.  
A few comments:  
1. The autho rs list the total number of complications between the two groups, but it would be 
interesting to know if certain complications were higher in the elderly group such as 
bleeding (given a higher percentage are likely on anti -coagulation), aspiration, cardiac  
abnormalities. Also, it would be helpful to know the breakdown of what complications 
occurred.  
2. The authors list 27 failures - 22 failed cannulation, 2 bradycardia, 1 perforation. What were 
the other 2?  
3. The authors state all patients were done unde r moderate sedation - did no patients require 
general anesthesia? Were patients who needed general anesthesia excluded?  
4. None of the patients in this series had malignant obstruction as the indication for ERCP -- 
were patients with cancer excluded? It s eems to me that a high percentage of older patients 
requiring ERCP are due to malignancy and it would be useful to know if the safety profile is 
as good in those patients since they tend to be longer and more complex ERCPs.  
5. Why did fewer patients in the elderly group have sphincterotomy? Is this because a higher 
percentage were on anti -coagulation? Could that be a factor in the lack of difference in 
complication rates between the gorups?  
6. This discussion is a bit long - I think it could be condensed a bit.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the a uthors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to t he authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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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