Reviewer ’s report  
 
Title: Gallbladder polyps - a follow -up study after 11 years  
 
Version: 0 Date: 05 Aug 2018  
 
Reviewer: Thomas Hugh  
 
Reviewer's report:  
 
This is an important study and a valuable contribution to the literature on this subje ct. 
The authors note that the prevalence of GB polyps is higher than has been documented in the 
past (12.1% instead of 6%). They rightly indicate that this may not be due to a true increase in 
prevalence but rather improvements in ultrasound sensitivity.  
The authors state that in the 2013 follow up study the prevalence of GB polyps was 12.1% 
(50/413 patients).  
Then they went on to describe 27 patients who had already had polyps and they showed that 
48.1% of these patients no longer had GB polyps. This is he lpful information that can reassure 
patients who are found to have GB polyps but do not have any symptoms to warrant 
cholecystectomy that  a follow up approach is justified.  
Half of the patients who had polyps in 2002 and still had them in 2013 had an inc rease in the size 
of the polyps.   
The other important information from this study is that 8.7% of patients who did not have GB 
polyps in the original study subsequently developed polyps. Predicting which patients might 
develop GB polyps, or which polyps m ight increase in size is not easy to do - do the authors have 
any comment on whether there were any clinical or morphological polyp features that might 
have identified those patients who developed polyps or those whose polyps increased in size or 
changed sh ape over time?  
 
The authors did not comment on the exact size of the polyps that had grown over the 11 year 
follow up period and whether these patients subsequently underwent cholecystectomy. It would 
be helpful to know if any of the polyps that increased in size were subject to histopathological 
examination. Were they all simple cholesterol polyps or were there any GB adenomas in this 
group?  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your commen ts to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the qua lity of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salar y from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publicati on of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my  report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access C reative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Gallbladder polyps - a follow -up study after 11 years  
 
Version: 0 Date: 05 Aug 2018  
 
Reviewer: Thomas Hugh  
 
Reviewer's report:  
 
This is an important study and a valuable contribution to the literature on this subje ct. 
The authors note that the prevalence of GB polyps is higher than has been documented in the 
past (12.1% instead of 6%). They rightly indicate that this may not be due to a true increase in 
prevalence but rather improvements in ultrasound sensitivity.  
The authors state that in the 2013 follow up study the prevalence of GB polyps was 12.1% 
(50/413 patients).  
Then they went on to describe 27 patients who had already had polyps and they showed that 
48.1% of these patients no longer had GB polyps. This is he lpful information that can reassure 
patients who are found to have GB polyps but do not have any symptoms to warrant 
cholecystectomy that  a follow up approach is justified.  
Half of the patients who had polyps in 2002 and still had them in 2013 had an inc rease in the size 
of the polyps.   
The other important information from this study is that 8.7% of patients who did not have GB 
polyps in the original study subsequently developed polyps. Predicting which patients might 
develop GB polyps, or which polyps m ight increase in size is not easy to do - do the authors have 
any comment on whether there were any clinical or morphological polyp features that might 
have identified those patients who developed polyps or those whose polyps increased in size or 
changed sh ape over time?  
 
The authors did not comment on the exact size of the polyps that had grown over the 11 year 
follow up period and whether these patients subsequently underwent cholecystectomy. It would 
be helpful to know if any of the polyps that increased in size were subject to histopathological 
examination. Were they all simple cholesterol polyps or were there any GB adenomas in this 
group?  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your commen ts to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the qua lity of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salar y from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publicati on of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my  report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access C reative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Gallbladder polyps - a follow -up study after 11 years  
 
Version: 0 Date: 05 Aug 2018  
 
Reviewer: Thomas Hugh  
 
Reviewer's report:  
 
This is an important study and a valuable contribution to the literature on this subje ct. 
The authors note that the prevalence of GB polyps is higher than has been documented in the 
past (12.1% instead of 6%). They rightly indicate that this may not be due to a true increase in 
prevalence but rather improvements in ultrasound sensitivity.  
The authors state that in the 2013 follow up study the prevalence of GB polyps was 12.1% 
(50/413 patients).  
Then they went on to describe 27 patients who had already had polyps and they showed that 
48.1% of these patients no longer had GB polyps. This is he lpful information that can reassure 
patients who are found to have GB polyps but do not have any symptoms to warrant 
cholecystectomy that  a follow up approach is justified.  
Half of the patients who had polyps in 2002 and still had them in 2013 had an inc rease in the size 
of the polyps.   
The other important information from this study is that 8.7% of patients who did not have GB 
polyps in the original study subsequently developed polyps. Predicting which patients might 
develop GB polyps, or which polyps m ight increase in size is not easy to do - do the authors have 
any comment on whether there were any clinical or morphological polyp features that might 
have identified those patients who developed polyps or those whose polyps increased in size or 
changed sh ape over time?  
 
The authors did not comment on the exact size of the polyps that had grown over the 11 year 
follow up period and whether these patients subsequently underwent cholecystectomy. It would 
be helpful to know if any of the polyps that increased in size were subject to histopathological 
examination. Were they all simple cholesterol polyps or were there any GB adenomas in this 
group?  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your commen ts to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the qua lity of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salar y from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publicati on of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my  report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access C reative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant