Review for 10.1186/s12876-025-03767-5 (2025)

Title: The usefulness of percutaneous bile duct metal stent insertion for malignant biliary
obstruction: a retrospective study
Version: 2 Date: 06 Jan 2025
Reviewer's report:
Manuscript Synopsis:
1- 14-case retrospective analysis of percutaneous biliary stent insertion.
Linguistic comments:
2- There are some syntactic errors. Please review and revise the manuscript to correct these
errors.
Scientific comments:
General Comments:
3- There is limited addition to the literature as percutaneous biliary metal stenting for malignant
strictures is a commonly performed procedure in interventional radiology.
Specific Comments:
Title:
4- Good.
Abstract:
5- Unless there are word restrictions, the abstract should be expanded.
Introduction:
6- Please give more detail of covered and uncovered metal stenting for the biliary tract.
7- Please give more detail of Gastroenterology vs. Interventional Radiology (IR) management
of malignant biliary strictures.
8- Page 2, Line 46: Do the authors mean Endoscopic Ultrasound (EUS) Guided biliary duct
cannulation when they say transdigestively? Please consider revising this term.
Materials and Methods:
9- Page 3, Line 54: Please mention that all 14 patients had malignant biliary obstruction.
10- Were all cases done with local anesthesia alone? No moderate sedation or deeper levels of
anesthesia?
11- Page 3, Line 64: Please consider replacing “breached” with crossed.
12- Please change Amplats with Amplatz throughout the manuscript.
13- The first and second stage procedures are not properly presented and confusing. It seems
that the order of procedures was as follows:
a. Percutaneous biliary access
b. Crossing of the stricture
c. Stent placement
d. Wire removal (Page 3: Line 68)
e. Second-stage. Do the authors mean to describe the two-stage procedure in this paragraph? If
so, second-stage should be changed to two-stage.
f. Drain placement.
g. Lateral hole creation (Page 3: Line 71). This is confusing. Was the hole created in the drain
or was there a separate bile duct puncture made?
14- How long did the authors wait in between drain placement and stent placement for the two-
stage procedure cases?
15- How and when were complications assessed?
16- Why did the authors not consider placing covered metal stents in these “palliative” cases?
Statistics:
17- Not applicable.
Results:
18- Page 4, Line 93. Please consider changing “gallbladder canal” to via the cystic duct.
19- Please mention the complications in the Results section. Was perihepatic bile leakage
assessed?
20- Was stent patency assessed? Please consider adding this variable and the way this was
calculated in the Materials and Methods.
21- Please define post-operative gastric cancer. This paragraph is confusing as it describes
patients with cholangiocarcinoma as well.
Discussion:
22- Page 7, Line 150. How was severe cholangitis diagnosed? Tokyo Guidelines?
23- Did the authors perform one-phase stent insertion in patients with mild or moderate acute
cholangitis?
24- Please also mention how this manuscript adds to the current literature on percutaneous metal
stenting.
References:
25- Good.
Tables/Figures:
26- Table 1: What do the phases mean? Please consider changing to “Single Stage” and “Two
Stage” for consistency.
27- Figure: It would be nice to have arrows describing various structures on the images.
28- Figure: Was the access through the gallbladder?