Title: Timing  and Other Factors Influencing Short#Term Outcomes of Endoscopic
Transpapillary Gallbladder Drainage for Acute Cholecystitis: A Retrospective Study
Version: 3 Date: 23 Apr 2025
Reviewer's report:
General Comments to the Authors
Thank you for the opportunity to review your revised manuscript. Your study addresses an
important technical and procedural aspect of endoscopic transpapillary gallbladder drainage
(ETGBD), particularly the influence of timing on short-term outcomes. The data are presented
clearly and the methodology appears sound.
However, I remain concerned that the clinical value of elective ETGBD is overstated in the
absence of any long-term outcome data. While the study shows improved short-term technical
success and fewer adverse events in elective cases, it does not demonstrate whether these
translate into meaningful clinical benefits, such as reduced recurrence, improved quality of life,
or better overall patient outcomes.
This issue was raised in previous reviews, but has not been substantively addressed. The
discussion should be revised to more explicitly acknowledge this limitation. In particular:
Clearly state that no long-term outcomes were evaluated.
Discuss how the prior use of PTGBD in the elective group may confound the results.
Avoid suggesting that elective ETGBD is clinically superior without supporting data.
If follow-up data are available, even limited, please consider including them. Otherwise, the
manuscript should be more cautious in its conclusions.
I believe the manuscript could still offer value if these limitations are properly discussed and
the conclusions appropriately tempered.
Title: Timing  and Other Factors Influencing Short#Term Outcomes of Endoscopic
Transpapillary Gallbladder Drainage for Acute Cholecystitis: A Retrospective Study
Version: 3 Date: 23 Apr 2025
Reviewer's report:
General Comments to the Authors
Thank you for the opportunity to review your revised manuscript. Your study addresses an
important technical and procedural aspect of endoscopic transpapillary gallbladder drainage
(ETGBD), particularly the influence of timing on short-term outcomes. The data are presented
clearly and the methodology appears sound.
However, I remain concerned that the clinical value of elective ETGBD is overstated in the
absence of any long-term outcome data. While the study shows improved short-term technical
success and fewer adverse events in elective cases, it does not demonstrate whether these
translate into meaningful clinical benefits, such as reduced recurrence, improved quality of life,
or better overall patient outcomes.
This issue was raised in previous reviews, but has not been substantively addressed. The
discussion should be revised to more explicitly acknowledge this limitation. In particular:
Clearly state that no long-term outcomes were evaluated.
Discuss how the prior use of PTGBD in the elective group may confound the results.
Avoid suggesting that elective ETGBD is clinically superior without supporting data.
If follow-up data are available, even limited, please consider including them. Otherwise, the
manuscript should be more cautious in its conclusions.
I believe the manuscript could still offer value if these limitations are properly discussed and
the conclusions appropriately tempered.
Please review this paper.
user
Title: Timing  and Other Factors Influencing Short#Term Outcomes of Endoscopic
Transpapillary Gallbladder Drainage for Acute Cholecystitis: A Retrospective Study
Version: 3 Date: 23 Apr 2025
Reviewer's report:
General Comments to the Authors
Thank you for the opportunity to review your revised manuscript. Your study addresses an
important technical and procedural aspect of endoscopic transpapillary gallbladder drainage
(ETGBD), particularly the influence of timing on short-term outcomes. The data are presented
clearly and the methodology appears sound.
However, I remain concerned that the clinical value of elective ETGBD is overstated in the
absence of any long-term outcome data. While the study shows improved short-term technical
success and fewer adverse events in elective cases, it does not demonstrate whether these
translate into meaningful clinical benefits, such as reduced recurrence, improved quality of life,
or better overall patient outcomes.
This issue was raised in previous reviews, but has not been substantively addressed. The
discussion should be revised to more explicitly acknowledge this limitation. In particular:
Clearly state that no long-term outcomes were evaluated.
Discuss how the prior use of PTGBD in the elective group may confound the results.
Avoid suggesting that elective ETGBD is clinically superior without supporting data.
If follow-up data are available, even limited, please consider including them. Otherwise, the
manuscript should be more cautious in its conclusions.
I believe the manuscript could still offer value if these limitations are properly discussed and
the conclusions appropriately tempered.
assistant