Review for 10.1186/s12876-022-02610-5 (2022)

Reviewer’s report
Title: 
Long-term outcomes of endoscopic transpapillary gallbladder drainage
using a novel spiral plastic stent in acute calculus cholecystitis
Version: 
0 
Date: 
05 May 2022
Reviewer's report:
The authors conduct a retrospective study to evaluate the long-term outcomes of
endoscopic transpapillary gallbladder stenting (EGBS) using a novel spiral-
shaped plastic stent. In this study, the authors included 49 acute calculous
cholecystitis patients (from 2011/1 to 2019/12). Clinical success rate was 97%.
After EGBS, 25 patients underwent elective cholecystectomy and 24 patients
didn't not (follow-up group). The median follow-up period was 236 days in the
follow-up group. Seven adverse events were observed in this group. Author
concluded EGBS using this novel spiral-shaped plastic stent is safe and effective
for long-term acute calculous cholecystitis. 
Followings are my comments:
1. The most novel part of this study is new spiral-shaped plastic stent for EGBS.
High technical successful rate in this study. Author could compare the difference
between traditional stent (double pigtail/straight) and this new one to elucidate
the superiority of spiral-shaped stent. 
2. EGBS is not new technique. One meta-analysis was published in 2021 (World
J Gastrointest Endosc 2021;13(8):345-355). 
Kim et al. also reported 155
successfully ETGBD procedures in 2020 (PLOS one). They maintained stent
insertion in 64 patients. 
3. Introduction section is short. Author could mention different treatment
modality in acute calculous cholecystitis (included PTGBD, EGBS,
cholecystectomy) and add new published references.
4. CBD stones were detected in 17 (35%) patients and EGBS was performed
instead of cholecystectomy in 16 patients. Indication or benefit of EGBS in these
patients? (prevention of recurrent cholecystitis?). These patients presented to
hospital with cholangitis or cholecystitis?
5. Late adverse events occurred in 7 patients (29%). This result is higher than
previous studies or not? Author only cite Ref 12 and 17. Is there other published
reports about this outcome?
6. Sample size is small (24 patients with maintained stent follow-up group) to
evaluate long term outcome.
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