Reviewer ’s report  
 
Title: Liver Elasticity Measurement Before and After Biliary Drainage in Patients With  
Obstructive Jaundice -A Prospect ive Cohort Study  
 
Version: 1 Date: 05 Mar 2016  
 
Reviewer: Kidist Yimam  
 
Reviewer's report:  
 
1. Thank you for performing the additional analysis to evaluate correlation between changes in 
ALP with change in hepatic elasticity (TE, VTQ -R and VTQ -L). Though the correlations 
were weak, consider including in your paper (at least in the discussion part) as readers will 
likely question if ALP may correlate better the TB.  
2. Page 18, line 27: regarding "patient selection" consider making it more to readers to why 
TB/ALP changes did not correlate well with TE, VTQ -R and VTQ -L.  
In addition to the small sample, all your patients were patients with malignant biliary obstruction 
of unknown duration, with possible sec ondary biliary fibrosis. We also don't how the location of 
the biliary obstruction affects TE or VTE -R/L values as the location of the malignant 
obstructions varied in your patient cohort.  
3. Page 18, line 34: "primary liver fibrosis" should be changed "secondary biliary fibrosis" due 
to extrahepatic obstruction. The authors have excluded patients with underlying chronic liver 
diseases.  
4. Overall, this study can be of interest as a proof o f concept. Though it has been previously 
reported that biliary obstruction can increase liver stiffness measured by TE, the correlation 
between change in hepatic elasticity and serum markers of fibrosis before and after 
alleviating biliary obstruction is i nteresting to report.  
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 comments to the authors.  
 
Unable to assess  
 
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 statis tics 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declar ation 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 salary 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 publication of this manuscript, eithe r 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 relatin g 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 websi te along with the authors' 
responses. I agree for my report to be made available under an Open Acce ss Creative 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 name d 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: Liver Elasticity Measurement Before and After Biliary Drainage in Patients With  
Obstructive Jaundice -A Prospect ive Cohort Study  
 
Version: 1 Date: 05 Mar 2016  
 
Reviewer: Kidist Yimam  
 
Reviewer's report:  
 
1. Thank you for performing the additional analysis to evaluate correlation between changes in 
ALP with change in hepatic elasticity (TE, VTQ -R and VTQ -L). Though the correlations 
were weak, consider including in your paper (at least in the discussion part) as readers will 
likely question if ALP may correlate better the TB.  
2. Page 18, line 27: regarding "patient selection" consider making it more to readers to why 
TB/ALP changes did not correlate well with TE, VTQ -R and VTQ -L.  
In addition to the small sample, all your patients were patients with malignant biliary obstruction 
of unknown duration, with possible sec ondary biliary fibrosis. We also don't how the location of 
the biliary obstruction affects TE or VTE -R/L values as the location of the malignant 
obstructions varied in your patient cohort.  
3. Page 18, line 34: "primary liver fibrosis" should be changed "secondary biliary fibrosis" due 
to extrahepatic obstruction. The authors have excluded patients with underlying chronic liver 
diseases.  
4. Overall, this study can be of interest as a proof o f concept. Though it has been previously 
reported that biliary obstruction can increase liver stiffness measured by TE, the correlation 
between change in hepatic elasticity and serum markers of fibrosis before and after 
alleviating biliary obstruction is i nteresting to report.  
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 comments to the authors.  
 
Unable to assess  
 
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 statis tics 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declar ation 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 salary 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 publication of this manuscript, eithe r 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 relatin g 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 websi te along with the authors' 
responses. I agree for my report to be made available under an Open Acce ss Creative 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 name d 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: Liver Elasticity Measurement Before and After Biliary Drainage in Patients With  
Obstructive Jaundice -A Prospect ive Cohort Study  
 
Version: 1 Date: 05 Mar 2016  
 
Reviewer: Kidist Yimam  
 
Reviewer's report:  
 
1. Thank you for performing the additional analysis to evaluate correlation between changes in 
ALP with change in hepatic elasticity (TE, VTQ -R and VTQ -L). Though the correlations 
were weak, consider including in your paper (at least in the discussion part) as readers will 
likely question if ALP may correlate better the TB.  
2. Page 18, line 27: regarding "patient selection" consider making it more to readers to why 
TB/ALP changes did not correlate well with TE, VTQ -R and VTQ -L.  
In addition to the small sample, all your patients were patients with malignant biliary obstruction 
of unknown duration, with possible sec ondary biliary fibrosis. We also don't how the location of 
the biliary obstruction affects TE or VTE -R/L values as the location of the malignant 
obstructions varied in your patient cohort.  
3. Page 18, line 34: "primary liver fibrosis" should be changed "secondary biliary fibrosis" due 
to extrahepatic obstruction. The authors have excluded patients with underlying chronic liver 
diseases.  
4. Overall, this study can be of interest as a proof o f concept. Though it has been previously 
reported that biliary obstruction can increase liver stiffness measured by TE, the correlation 
between change in hepatic elasticity and serum markers of fibrosis before and after 
alleviating biliary obstruction is i nteresting to report.  
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 comments to the authors.  
 
Unable to assess  
 
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 statis tics 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declar ation 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 salary 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 publication of this manuscript, eithe r 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 relatin g 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 websi te along with the authors' 
responses. I agree for my report to be made available under an Open Acce ss Creative 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 name d 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