Reviewer's report
Title:Transient elastography for predicting esophageal/gastric varices in children
with biliary atresia
Version: 1Date:30 January 2011
Reviewer: giada Sebastiani
Reviewer's report:
MAJOR COMPULSORY REVISIONS
The study by Chongsrisawat et al deals with non-invasive detection of
oesophageal varices in children by transient elastography and simple serum
biomarkers. This is an interesting topic and there is not a lot of literature about it.
However, I have some major concerns that the authors should address.
- splenomegaly was detected with physical examination. Was this then confirmed
with abdominal ultrasound? If so, also ultrasound results should be included in
the results and in the methods.
- RESULTS: this section is very limited and it should be expanded. For example,
more data about the performance of the methods (transient elastography and
serum markers) must be included. Predictive values, accuracy, likelihood ratios
must be included. The authors should also comment on the predictive values
since the area under the ROC curve has not much value in clinical practice. A
very high negative predictive value could be very useful to exclude children who
need an endoscopy. Also refer to a recent study (Sebastiani et al, J Hepatol
2010), that is one of the largest about chronic liver diseases, that has developed
an algorithm based on simple non-invasive test. Maybe the authors could apply
some of these simple and cheap tests. Moreover, they should propose an
algorithm based on their results to be used in clinical practice. Also a cost-benefit
analysis should be included accordingly. Finally, the area under the ROC curve
should be used especially to define cut-off of the markers that could have high
predictive values to rule-out or rule-in oesophageal varices. Unfortunately, all this
analysis is lacking and the present data are insufficient. The above mentioned
results should also be carefully commented in the discussion.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Transient elastography for predicting esophageal/gastric varices in children
with biliary atresia
Version: 1Date:30 January 2011
Reviewer: giada Sebastiani
Reviewer's report:
MAJOR COMPULSORY REVISIONS
The study by Chongsrisawat et al deals with non-invasive detection of
oesophageal varices in children by transient elastography and simple serum
biomarkers. This is an interesting topic and there is not a lot of literature about it.
However, I have some major concerns that the authors should address.
- splenomegaly was detected with physical examination. Was this then confirmed
with abdominal ultrasound? If so, also ultrasound results should be included in
the results and in the methods.
- RESULTS: this section is very limited and it should be expanded. For example,
more data about the performance of the methods (transient elastography and
serum markers) must be included. Predictive values, accuracy, likelihood ratios
must be included. The authors should also comment on the predictive values
since the area under the ROC curve has not much value in clinical practice. A
very high negative predictive value could be very useful to exclude children who
need an endoscopy. Also refer to a recent study (Sebastiani et al, J Hepatol
2010), that is one of the largest about chronic liver diseases, that has developed
an algorithm based on simple non-invasive test. Maybe the authors could apply
some of these simple and cheap tests. Moreover, they should propose an
algorithm based on their results to be used in clinical practice. Also a cost-benefit
analysis should be included accordingly. Finally, the area under the ROC curve
should be used especially to define cut-off of the markers that could have high
predictive values to rule-out or rule-in oesophageal varices. Unfortunately, all this
analysis is lacking and the present data are insufficient. The above mentioned
results should also be carefully commented in the discussion.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Transient elastography for predicting esophageal/gastric varices in children
with biliary atresia
Version: 1Date:30 January 2011
Reviewer: giada Sebastiani
Reviewer's report:
MAJOR COMPULSORY REVISIONS
The study by Chongsrisawat et al deals with non-invasive detection of
oesophageal varices in children by transient elastography and simple serum
biomarkers. This is an interesting topic and there is not a lot of literature about it.
However, I have some major concerns that the authors should address.
- splenomegaly was detected with physical examination. Was this then confirmed
with abdominal ultrasound? If so, also ultrasound results should be included in
the results and in the methods.
- RESULTS: this section is very limited and it should be expanded. For example,
more data about the performance of the methods (transient elastography and
serum markers) must be included. Predictive values, accuracy, likelihood ratios
must be included. The authors should also comment on the predictive values
since the area under the ROC curve has not much value in clinical practice. A
very high negative predictive value could be very useful to exclude children who
need an endoscopy. Also refer to a recent study (Sebastiani et al, J Hepatol
2010), that is one of the largest about chronic liver diseases, that has developed
an algorithm based on simple non-invasive test. Maybe the authors could apply
some of these simple and cheap tests. Moreover, they should propose an
algorithm based on their results to be used in clinical practice. Also a cost-benefit
analysis should be included accordingly. Finally, the area under the ROC curve
should be used especially to define cut-off of the markers that could have high
predictive values to rule-out or rule-in oesophageal varices. Unfortunately, all this
analysis is lacking and the present data are insufficient. The above mentioned
results should also be carefully commented in the discussion.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.
assistant