Title: Risk Factors and Clinical Characteristics of Occult Pancreaticobiliary Reflux in Benign
Gallbladder Diseases
Version: 1 Date: 11 Jun 2024
Reviewer's report:
The authors studied 80 of 578 patients with normal pancreaticobiliary junction who underwent
surgery for benign gallbladder disease and had occult pancreaticobiliary reflux (OPBR).
In results, patients with OPBR were generally older and more likely to have GS, but less likely
to have GP. Patients over 50 and those in GA and GS alone group faced higher OPBR risk. In
patients with GS, the incidence of OPBR correlated with stone size. Biliary sludge (<3 mm)
and high #-glutamyl transferase were risk factors in GA, while biliary sludge and age >50 years
were risk factors in GS alone group.
They concluded that in GS alone or GA patients, biliary sludge should raise OPBR concerns,
necessitating tailored clinical attention.
They studied OPBR patients in detail, with interesting results. However, it is redundant and in
some places leaps of logic are evident. Major revisions are necessary.
Major
## The main drawback of this article is that it does not include gallbladder cancer. Even if the
characteristics of OPBR in benign disease are known, the risk of gallbladder cancer cannot be
avoided.
## The argument that gallstones are a risk for gallbladder cancer is still inconclusive. Citing
only one side of the argument is problematic.
## It is unclear how the diagnosis of NPBJ was made. It does not specify what imaging studies
were used to make the diagnosis before surgery.
## There are three types of adenomyomatosis: localized, segmental, and diffuse. They did not
show the type of GA. The results show that “all patients in Group A had gallbladder wall
thickening (gallbladder wall thickness > 3 mm)”, but it is not surprising that diffuse type
adenomyomatosis would have wall thickening.
## Table 4 has so much data that it is not at all clear what is being described. It is a meaningless
table. The significant differences shown in Table 4 between the four groups do not appear to be
a direct risk of developing gallbladder cancer.
## They mentioned that the patient with OPBR would need long-term follow-up, because the
reflux of pancreatic juice still exists after cholecystectomy, which is considered a risk factor
for bile duct cancer [10]. However, the study is based of only 47 patients with symptomatic
gallstones, which is not universal: the suspected OPBR patients were older, had higher degrees
of inflammation and higher Ki-67 positivity. Furthermore, there is clearly a leap in logic, as I can
find no article that states that cholangiocarcinoma is more likely to occur after cholecystectomy.
There is a danger of spreading erroneous opinions.
Title: Risk Factors and Clinical Characteristics of Occult Pancreaticobiliary Reflux in Benign
Gallbladder Diseases
Version: 1 Date: 11 Jun 2024
Reviewer's report:
The authors studied 80 of 578 patients with normal pancreaticobiliary junction who underwent
surgery for benign gallbladder disease and had occult pancreaticobiliary reflux (OPBR).
In results, patients with OPBR were generally older and more likely to have GS, but less likely
to have GP. Patients over 50 and those in GA and GS alone group faced higher OPBR risk. In
patients with GS, the incidence of OPBR correlated with stone size. Biliary sludge (<3 mm)
and high #-glutamyl transferase were risk factors in GA, while biliary sludge and age >50 years
were risk factors in GS alone group.
They concluded that in GS alone or GA patients, biliary sludge should raise OPBR concerns,
necessitating tailored clinical attention.
They studied OPBR patients in detail, with interesting results. However, it is redundant and in
some places leaps of logic are evident. Major revisions are necessary.
Major
## The main drawback of this article is that it does not include gallbladder cancer. Even if the
characteristics of OPBR in benign disease are known, the risk of gallbladder cancer cannot be
avoided.
## The argument that gallstones are a risk for gallbladder cancer is still inconclusive. Citing
only one side of the argument is problematic.
## It is unclear how the diagnosis of NPBJ was made. It does not specify what imaging studies
were used to make the diagnosis before surgery.
## There are three types of adenomyomatosis: localized, segmental, and diffuse. They did not
show the type of GA. The results show that “all patients in Group A had gallbladder wall
thickening (gallbladder wall thickness > 3 mm)”, but it is not surprising that diffuse type
adenomyomatosis would have wall thickening.
## Table 4 has so much data that it is not at all clear what is being described. It is a meaningless
table. The significant differences shown in Table 4 between the four groups do not appear to be
a direct risk of developing gallbladder cancer.
## They mentioned that the patient with OPBR would need long-term follow-up, because the
reflux of pancreatic juice still exists after cholecystectomy, which is considered a risk factor
for bile duct cancer [10]. However, the study is based of only 47 patients with symptomatic
gallstones, which is not universal: the suspected OPBR patients were older, had higher degrees
of inflammation and higher Ki-67 positivity. Furthermore, there is clearly a leap in logic, as I can
find no article that states that cholangiocarcinoma is more likely to occur after cholecystectomy.
There is a danger of spreading erroneous opinions.
Please review this paper.
user
Title: Risk Factors and Clinical Characteristics of Occult Pancreaticobiliary Reflux in Benign
Gallbladder Diseases
Version: 1 Date: 11 Jun 2024
Reviewer's report:
The authors studied 80 of 578 patients with normal pancreaticobiliary junction who underwent
surgery for benign gallbladder disease and had occult pancreaticobiliary reflux (OPBR).
In results, patients with OPBR were generally older and more likely to have GS, but less likely
to have GP. Patients over 50 and those in GA and GS alone group faced higher OPBR risk. In
patients with GS, the incidence of OPBR correlated with stone size. Biliary sludge (<3 mm)
and high #-glutamyl transferase were risk factors in GA, while biliary sludge and age >50 years
were risk factors in GS alone group.
They concluded that in GS alone or GA patients, biliary sludge should raise OPBR concerns,
necessitating tailored clinical attention.
They studied OPBR patients in detail, with interesting results. However, it is redundant and in
some places leaps of logic are evident. Major revisions are necessary.
Major
## The main drawback of this article is that it does not include gallbladder cancer. Even if the
characteristics of OPBR in benign disease are known, the risk of gallbladder cancer cannot be
avoided.
## The argument that gallstones are a risk for gallbladder cancer is still inconclusive. Citing
only one side of the argument is problematic.
## It is unclear how the diagnosis of NPBJ was made. It does not specify what imaging studies
were used to make the diagnosis before surgery.
## There are three types of adenomyomatosis: localized, segmental, and diffuse. They did not
show the type of GA. The results show that “all patients in Group A had gallbladder wall
thickening (gallbladder wall thickness > 3 mm)”, but it is not surprising that diffuse type
adenomyomatosis would have wall thickening.
## Table 4 has so much data that it is not at all clear what is being described. It is a meaningless
table. The significant differences shown in Table 4 between the four groups do not appear to be
a direct risk of developing gallbladder cancer.
## They mentioned that the patient with OPBR would need long-term follow-up, because the
reflux of pancreatic juice still exists after cholecystectomy, which is considered a risk factor
for bile duct cancer [10]. However, the study is based of only 47 patients with symptomatic
gallstones, which is not universal: the suspected OPBR patients were older, had higher degrees
of inflammation and higher Ki-67 positivity. Furthermore, there is clearly a leap in logic, as I can
find no article that states that cholangiocarcinoma is more likely to occur after cholecystectomy.
There is a danger of spreading erroneous opinions.
assistant