Review for 10.1186/s12876-020-01565-9 (2020)

Reviewer’s report
Title: 
Endoscopic Ultrasound with Fine Needle Aspiration is useful in
pancreatic cysts smaller than 3 cm
Version: 
0 
Date: 
05 Jul 2020
Reviewer's report:
The authors looked at pancreatic cysts <3 cm that are usually considered low-risk
by current guidelines. Based on their results, they maintain that there is no
significant difference between cysts smaller and greater than 3 cm, and that cyst
size alone should not be taken as a determinant to establish malignant potential. 
Overall, the study appears well conducted and documented. The methods are
clear and the discussion is balanced. I have a few remarks
1) Case selection is what bothers me most. The authors enrolled 115/167 patients
presenting with pancreatic cysts <3 cm. The reasons for excluding 52 patients
should be elucidated as these represented a significant amount of the whole
population.
2) Please explain the reasons for employing a 25-Gauge needle, which is not the
preferred choice when cystic fluid has to be aspirated. Maybe solid components
were the main target in these cases?
3) Please explain the reasons for prolonging ciprofloxacin for five days after the
procedure especially in light of recent literature evidence showing that antibiotic
prophylaxis might not be needed at all before EUS-FNA of pancreatic cysts.
4) I believe that the striking difference in malignancy rates between symptomatic
and non-symptomatic patients is not adequately emphasized in the discussion. In
these difficult-to-manage conditions, it is very important that we behave as fully
developed clinicians and not restrict ourselves just to EUS features evaluation.
5) Page 7, line 143: please amend "septa"
6) Page 10, line 233: amend "mass"
7) Page 10, line 237-238: please use past tense if you are referring to your own
results. On the contrary, this sentence should be moved to the discussion.
8) Please discuss briefly the role of CH-EUS in this context.
9) Literature to be cited:
Colán-Hernández J, Sendino O, Loras C, et al. Antibiotic Prophylaxis Is Not
Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of
Pancreatic Cystic Lesions, Based on a Randomized Trial. Gastroenterology
2020;158:1642-1649.
Fusaroli, P., Serrani, M., De Giorgio, R., D'Ercole, M.C., Ceroni, L., Lisotti, A.,
Caletti, G. Contrast Harmonic-Endoscopic Ultrasound Is Useful to Identify
Neoplastic Features of Pancreatic Cysts (With Videos) Pancreas 2016;45:265-
268. 
Fusaroli, P., Kypraios, D., Eloubeidi, M.A., Caletti, G. Levels of evidence in
endoscopic ultrasonography: A systematic review Digestive Diseases and
Sciences 2012;57:602-609. 
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