Title: Cholelithiasis and Cholecystitis in Children and Adolescents: does this increasing
diagnosis require a common guideline for pediatricians and pediatric surgeons?
Version: 3 Date: 21 Mar 2021
Reviewer's report:
Thank you for addressing the raised comments. Some methodological issues remain and not all
comment are  fully addressed.
Results
Not weight or length separately but only BMI can be reported for those under 18 years; Also
report the number of children with obesity according to BMI percentile (only % of overweight
now mentioned)
Influence of different case mix of complicated and uncomplicated cases in table 2 and kind of
complications complications (cystitis, cholangitis, pancreatitis, cholestasis, colics…) and table
3 should be reported and its influence discussed in the discussion section.
Figure 3 and its added description still leaves several questions open: What is the role of MRCP
and endosonography in case of US proven choldocholithiasis; what is the evidence of fasting
(none I am aware of): in which case antibiotics should be administered (my opinion: only in
case of changitis and should prompt rapid ERCP/cholecystectomy) ; diagnostics for pancreatitis
is missing
Discussion section:
Still a lack of detail on limitations/quality of the studies that are referred to: Important to mention
particularly a ‘high risk of selection bias‘
Limitations:
the added phrase is not clear enough: ‘’The study’s approach was chosen from the therapeutic
endpoint of cholecystectomy, which influences the selection of patients (bias) and might
therefore have an impact on the findings of the presented data ‘’  No conclusions can be made
on the risk benefit of a an expectant management as successful cases who do not undergo
cystectomy especially in asymptomatic cases can not be established.
Title: Cholelithiasis and Cholecystitis in Children and Adolescents: does this increasing
diagnosis require a common guideline for pediatricians and pediatric surgeons?
Version: 3 Date: 21 Mar 2021
Reviewer's report:
Thank you for addressing the raised comments. Some methodological issues remain and not all
comment are  fully addressed.
Results
Not weight or length separately but only BMI can be reported for those under 18 years; Also
report the number of children with obesity according to BMI percentile (only % of overweight
now mentioned)
Influence of different case mix of complicated and uncomplicated cases in table 2 and kind of
complications complications (cystitis, cholangitis, pancreatitis, cholestasis, colics…) and table
3 should be reported and its influence discussed in the discussion section.
Figure 3 and its added description still leaves several questions open: What is the role of MRCP
and endosonography in case of US proven choldocholithiasis; what is the evidence of fasting
(none I am aware of): in which case antibiotics should be administered (my opinion: only in
case of changitis and should prompt rapid ERCP/cholecystectomy) ; diagnostics for pancreatitis
is missing
Discussion section:
Still a lack of detail on limitations/quality of the studies that are referred to: Important to mention
particularly a ‘high risk of selection bias‘
Limitations:
the added phrase is not clear enough: ‘’The study’s approach was chosen from the therapeutic
endpoint of cholecystectomy, which influences the selection of patients (bias) and might
therefore have an impact on the findings of the presented data ‘’  No conclusions can be made
on the risk benefit of a an expectant management as successful cases who do not undergo
cystectomy especially in asymptomatic cases can not be established.
Please review this paper.
user
Title: Cholelithiasis and Cholecystitis in Children and Adolescents: does this increasing
diagnosis require a common guideline for pediatricians and pediatric surgeons?
Version: 3 Date: 21 Mar 2021
Reviewer's report:
Thank you for addressing the raised comments. Some methodological issues remain and not all
comment are  fully addressed.
Results
Not weight or length separately but only BMI can be reported for those under 18 years; Also
report the number of children with obesity according to BMI percentile (only % of overweight
now mentioned)
Influence of different case mix of complicated and uncomplicated cases in table 2 and kind of
complications complications (cystitis, cholangitis, pancreatitis, cholestasis, colics…) and table
3 should be reported and its influence discussed in the discussion section.
Figure 3 and its added description still leaves several questions open: What is the role of MRCP
and endosonography in case of US proven choldocholithiasis; what is the evidence of fasting
(none I am aware of): in which case antibiotics should be administered (my opinion: only in
case of changitis and should prompt rapid ERCP/cholecystectomy) ; diagnostics for pancreatitis
is missing
Discussion section:
Still a lack of detail on limitations/quality of the studies that are referred to: Important to mention
particularly a ‘high risk of selection bias‘
Limitations:
the added phrase is not clear enough: ‘’The study’s approach was chosen from the therapeutic
endpoint of cholecystectomy, which influences the selection of patients (bias) and might
therefore have an impact on the findings of the presented data ‘’  No conclusions can be made
on the risk benefit of a an expectant management as successful cases who do not undergo
cystectomy especially in asymptomatic cases can not be established.
assistant