Review for 10.1186/1471-230X-11-69 (2011)

Reviewer's report
Title:Endoscopic papillary large balloon dilation alone without sphincterotomy for
the treatment of large common bile duct stones
Version: 1Date:21 April 2011
Reviewer: Young Koog Cheon
Reviewer's report:
(Major Compulsory revisions)
Major Comments
1. There are no new ones when it compared to the previous reports related to
large balloon for common bile duct stones. (See ref. # 16, Jeong S et al.
Gastrointestinal endoscopy 2009;70(5):915-922)
2. The large balloon papillary dilation itself is a risk factor of post-ERCP
pancreatitis, although the incidence is much lower comparing with EPBD.
Additionally, the rate of pancreatic duct contrast injection was 26.7%. But the
post-ERCP pancreatitis was very low (0.8%). This value is not trustworthy. The
authors should describe the cause of the low rate of post-ERCP pancreatitis in
the ‘Discussion’ part.
3. What are the causes of failure of the second attempt of stone extraction? The
authors should describe it in the ‘Result’ section.
4. The authors should clarify the characteristics of recurrent stones. For example,
the high incidence of mechanical lithotripsy, marked dilatation of common bile
duct, and/or old age in the cases of recurrent stones.
5. There were many sentences which were not related the main topic of this
manuscript. Therefore some sentences should be omitted.
Generally, this manuscript had too much redundant detail.
In ‘Methods’ of Abstract, please delete the ‘Endoscopic papillary large
balloon……..mechanical lithotripsy.’
In ‘Results’ of Abstract, please delete the ‘The most frequent presenting…….one
major systemic disease’ and last part of ‘Repeated ERCP with stone ……..sent
for surgery.’
In ‘Background’ part, the first paragraph is not necessary and so it should be
deleted. ‘Endoscopic sphinctertomy …..in 1974.’ and ‘Moreover, it cause more
complications…..(ERCP) alone’.
You also described about EPBD in the ‘Background’ redundantly. Please
describe only the key points and the weakness of EPBD briefly.
The ‘Discussion’ part also too much redundant detail, esp., EPBD.
Please describe and emphasize the large balloon papillary dilation.
6. Please clarify the detailed number and disease titles of systemic disease in
table 2.
Minor comments
1. Please clarify the number of stones (mean and range) in the “Result’ section.
2. The distal bile duct stricture was an important contraindication to the large
balloon dilatation because perforation might be developed during dilatation. Are
there cases of distal bile duct stricture?
3. What is the reference when you decide the size of balloon? Please clarify it in
the ‘Methods’ section?
4. The platelet count itself is not related with bleeding unless it is less than
40,000 cumm-1. Did you check the prothrombin time or INR? If you did, please
show us prothrombin time or INR instead of platelet count.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'