Review for 10.1186/s12876-022-02168-2 (2022)

Reviewer’s report
Title: 
Transjugular intrahepatic portosystemic shunt for the treatment of portal
hypertensive biliopathy with cavernous transformation of the portal vein: a case
report
Version: 
0 
Date: 
06 Aug 2021
Reviewer: 
Ippei Matsumoto
Reviewer's report:
This manuscript presents a case report showing the usefulness of transjugular
intrahepatic portosystemic shunt (TIPS) combined transjugular/transsplenic
approach to the patient with portal hypertensive biliopathy (PHB) with
cavernous transformation of the portal vein. There are some reports of
transjugular/transsplenic approach to the case of unidentified portal vein such as
portal vein thrombosis 1-3, but few reports of transjugular/transsplenic approach
to PHB with cavernous transformation of the portal vein. In the case which trunk
and branch of portal vein was totally replaced by cavernous vessels, this
approach may be effective in identifying suitable collateral vessels for shunting
(thick and straight etc.) and as a puncture guide for stent placement. Therefore, 
this report is a rare and this approach could be an alternative treatment option for
PHB cases where conventional TIPS procedures are difficult.
However, there are several problems that need to be revised in the text.
The comments are summarized below.
Major comments
1 The content of the Discussion section as a whole is unclear and lacking in
depth. Authors should explain point by point what is novel, how useful and
potential alternative treatment option it is
2 The image of the figure.1 is rough as a whole. It is unreasonable to show that
the multiple tortuous hepatopetal collateral vessels was compressing the common
bile duct and proximal bile duct dilated in this MRCP image. If possible, we
recommend replacing or adding a more appropriate image, including the
portography image.
3 In the text, authors are described as there is no consensus regarding to the
optimal treatment for PHB (page3 line58-59). Addition, it is stated that the
jaundice did not improve after medical treatment (page4 line54-55). Although
previous systematic review has reported therapeutic approaches for PHB 4, the
treatment content and policy for this case should be described in a little more
detail in comparison with past reports. At least in the Discussion section, you
should explain how you came to this therapeutic approach.
Minor comments
1) Background section (page4 line10-11)
"At present, a few of studies have reported that transjugular intrahepatic
portosystemic shunt (TIPS) can treat the symptomatic PHB, but it is very
difficult to perform in the patients who have cavernous transformation of portal
vein."
Please list references.
2)Abstract; Case presentation (page3 line4-5)
"A 23-year-old man with liver cirrhosis caused by hepatolenticular degeneration
presented with jaundice."
Text; Case presentation (page4 line31-32)
"A 23-year-old man presented with 1 month of yellowed skin and sclera."
It may be better to include the disease name in the case presentation of the text.
3)Discussion and Conclusions (page5 line52-53)
"Indication of TIPS in PHB is given by the requirement to decompress the portal
system and to resolve the biliary obstruction following detension of portal
collateral vessels."
What does detension mean?
4) In the background section, "TIPS" is spelled out two times.
1. Kallini JR, Gabr A, Kulik L, et al. Noncirrhotic complete obliterative portal
vein thrombosis: Novel management using trans-splenic transjugular intrahepatic
portosystemic shunt with portal vein recanalization. Hepatology. Apr
2016;63(4):1387-1390.
2. Salsamendi JT, Gortes FJ, Shnayder M, Doshi MH, Fan J, Narayanan G.
Transsplenic portal vein reconstruction-transjugular intrahepatic portosystemic
shunt in a patient with portal and splenic vein thrombosis. Radiol Case Rep. Sep
2016;11(3):186-189.
3. Cheng Z, Wang F, Liu J. Transjugular intrahepatic portosystemic shunt
assisted with trans-splenic access. Clin Mol Hepatol. Dec 2019;25(4):417-419.
4. Franceschet I, Zanetto A, Ferrarese A, Burra P, Senzolo M. Therapeutic
approaches for portal biliopathy: A systematic review. World journal of
gastroenterology. Dec 7 2016;22(45):9909-9920.
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