Title: Effect of Biliopancreatic Tree Anatomy on Development of Acute Gallstone Pancreatitis
Version: 1 Date: 08 Nov 2024
Reviewer's report:
This manuscript examines the influence of the anatomy of the pancreaticobiliary tract on the
development of biliary pancreatitis. This is a retrospective analysis.
Apart from some minor superficialities, the work has significant shortcomings.
Minor points:
• The literature is not always very carefully cited. In the introduction, reviews are cited to support
hypotheses that should actually be based on original data.
Major points
• There are also relevant disadvantages in the definition of the patient population. Patients with
acute pancreatitis were included retrospectively. How the diagnosis was made and whether the
correctness of the diagnosis was verified is not defined.
• There is also no clear definition of ‘gallstone-associated pancreatitis’.
• The control group consists of patients with elevated liver function tests. This should be more
specified in order to exclude possible selection bias for investigations of anatomical variants of
the bile ducts.
• It is also not clear why only patients with ‘normal’ anatomy of the biliary tract and pancreatic
duct system were included in the control group and what the definition of ‘normal’ is.
• The high proportion of MRCP examinations in the patient group in which the diagnosis of
biliary pancreatitis could obviously not be made sonographically is striking. This could also
represent a selection bias, as it is possible that sonographic visualisation of the entire DHC is
differently difficult in patients with certain anatomical variants.
• Were the criteria used to categorise anatomical variants chosen arbitrarily or is there evidence
in the literature to justify this choice?
Overall, the selection of study patients and control group appears unsuitable for answering the
question of whether anatomical variants of the ductal system represent a predisposition to biliary
pancreatitis. It would be better to compare patients with gallstone disease and acute pancreatitis
with patients with gallstone disease and no history of pancreatitis.
Title: Effect of Biliopancreatic Tree Anatomy on Development of Acute Gallstone Pancreatitis
Version: 1 Date: 08 Nov 2024
Reviewer's report:
This manuscript examines the influence of the anatomy of the pancreaticobiliary tract on the
development of biliary pancreatitis. This is a retrospective analysis.
Apart from some minor superficialities, the work has significant shortcomings.
Minor points:
• The literature is not always very carefully cited. In the introduction, reviews are cited to support
hypotheses that should actually be based on original data.
Major points
• There are also relevant disadvantages in the definition of the patient population. Patients with
acute pancreatitis were included retrospectively. How the diagnosis was made and whether the
correctness of the diagnosis was verified is not defined.
• There is also no clear definition of ‘gallstone-associated pancreatitis’.
• The control group consists of patients with elevated liver function tests. This should be more
specified in order to exclude possible selection bias for investigations of anatomical variants of
the bile ducts.
• It is also not clear why only patients with ‘normal’ anatomy of the biliary tract and pancreatic
duct system were included in the control group and what the definition of ‘normal’ is.
• The high proportion of MRCP examinations in the patient group in which the diagnosis of
biliary pancreatitis could obviously not be made sonographically is striking. This could also
represent a selection bias, as it is possible that sonographic visualisation of the entire DHC is
differently difficult in patients with certain anatomical variants.
• Were the criteria used to categorise anatomical variants chosen arbitrarily or is there evidence
in the literature to justify this choice?
Overall, the selection of study patients and control group appears unsuitable for answering the
question of whether anatomical variants of the ductal system represent a predisposition to biliary
pancreatitis. It would be better to compare patients with gallstone disease and acute pancreatitis
with patients with gallstone disease and no history of pancreatitis.
Please review this paper.
user
Title: Effect of Biliopancreatic Tree Anatomy on Development of Acute Gallstone Pancreatitis
Version: 1 Date: 08 Nov 2024
Reviewer's report:
This manuscript examines the influence of the anatomy of the pancreaticobiliary tract on the
development of biliary pancreatitis. This is a retrospective analysis.
Apart from some minor superficialities, the work has significant shortcomings.
Minor points:
• The literature is not always very carefully cited. In the introduction, reviews are cited to support
hypotheses that should actually be based on original data.
Major points
• There are also relevant disadvantages in the definition of the patient population. Patients with
acute pancreatitis were included retrospectively. How the diagnosis was made and whether the
correctness of the diagnosis was verified is not defined.
• There is also no clear definition of ‘gallstone-associated pancreatitis’.
• The control group consists of patients with elevated liver function tests. This should be more
specified in order to exclude possible selection bias for investigations of anatomical variants of
the bile ducts.
• It is also not clear why only patients with ‘normal’ anatomy of the biliary tract and pancreatic
duct system were included in the control group and what the definition of ‘normal’ is.
• The high proportion of MRCP examinations in the patient group in which the diagnosis of
biliary pancreatitis could obviously not be made sonographically is striking. This could also
represent a selection bias, as it is possible that sonographic visualisation of the entire DHC is
differently difficult in patients with certain anatomical variants.
• Were the criteria used to categorise anatomical variants chosen arbitrarily or is there evidence
in the literature to justify this choice?
Overall, the selection of study patients and control group appears unsuitable for answering the
question of whether anatomical variants of the ductal system represent a predisposition to biliary
pancreatitis. It would be better to compare patients with gallstone disease and acute pancreatitis
with patients with gallstone disease and no history of pancreatitis.
assistant