Exerting Forces and Wall Load during Duodenoscopy for ERCP: An Experimental Measurement in an Artificial Model

Round 1

Reviewer 1 Report

Dear Schneider and the group,

It was my pleasure to read your manuscript related to the duodenal luminal pressure and stress during ERCP procedures. It was very interesting and stimulating. My suggestion is that can you add a couple more coloured diagrams to represent the pressure changes during the procedure. This would be very interesting for the readers.

Best wishes.

Author Response

Thank you for the positive review of the manuscript. We inserted Figure 4 (new) with a diagram of the single endoscope tests.

Reviewer 2 Report

The difficult endoscopic examination technique, known as endoscopic retrograde cholangiopancreatography (ERCP), is performed with a side-viewing endoscope. Due to this configuration, the movement inside the intestine is not under direct visual control, therefore susceptible to maneuvers that are not always efficient and sometimes cause perforation. with latex models that the work intends to solve is highly limiting both due to the different skills of operators from less experienced to expert endoscopists and from the different anatomical areas of investigation. Although far from interventional clinical practice, these methods described above can be a reason for in vivo study.

Author Response

Thank you for the positive review of the manuscript. The reviewer is correct in pointing out that measurements in a latex model can only give indicative values and the results cannot be directly extrapolated to conditions in humans. This is the first intraprocedural measurement in a model. Further, in the course of time also insitu measurements can develop from the present approach.