Review for 10.1186/s12876-022-02162-8 (2022)

Reviewer’s report
Title: 
Endoscopic ultrasound avoids adverse events in high probability
choledocholithiasis patients with a negative computed tomography
Version: 
0 
Date: 
18 Sep 2021
Reviewer's report:
This is a prospective study of EUS first and ERCP first for high risk CBD stones
with negative CT.
1. The study results are quite predictable since true positive rate was reportedly
about 40% in high risk cases. The accuracy and safety of EUS is well known and
if we perform EUS in the population with 40% of CBD stones, it is natural that
EUS first approach can avoid unnecessary ERCP. The authors should add the
cost analysis to prove the superiority of EUS firs approach.
2. Since this is not RCT, the true positive rate was different between two groups.
The low rate of EUS group suggested that there was a bias and the physicians
selected EUS approach because they somehow predicted negative CBD stones. I
am curious the authors can explore how the decision was made for EUS or
ERCP first approach, so that we can stratify the high risk group further and select
appropriate approach.
3. For recurrent CBD stones, how did the authors diagnose residual stones or
not?
4. The recurrence rate appears too high. Any suggestions for this high recurrent
rate?
5. The authors should add severity of AEs.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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