Reviewer ’s report  
 
Title: Bile cholesterol and viscosity, the keys to discriminating adenomatous polyps from  
cholesterol polyps by a novel predictive scoring model.  
 
Version: 0 Date: 28 Apr 2020  
 
Reviewer: Chengtang Chiu  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annota ted versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comments to the authors.  
 
(1) The manuscript is not easy to read, as there are many grammatic/syntactic errors or non -
standard English usages that require correction. Significant English language editing, preferably 
by a native speaker, is required to improve the quality of this manuscript. Take the following 
sentences for example.  
 
Page3, line11  
"However, for polyps larger than 10 mm in size, the morphologically distinctive size -based 
classification is limited to accurately distinguishing adenomatous polyps from cholesterol polyps 
that do not require cholecystectomy."  
 
Page 4, line  11  
"The benign polyps were subdivided into cholesterol polyps in most cases and rarely, the non -
cholesterol polyps consisted of adenomyomatosis, hyperplastic polyps, and inflammatory polyps."  
 
Page 10, line 35:  
"The cutoff value of 55 years old is presen ted as a singularity, which is relatively younger than the 
cutoff value commonly mentioned in previous studies."  
 
(3) Page 3, line 16  
"However, cholesterol polyps are generally characterized by cholesterol, a lipid component that is 
very distinct from the  components of adenomatous polyps."  
 
Comment: It seems weird to compare "cholesterol" with "the components of adenomatous polyps", 
which consist of dysplastic epithelial cells. Consider use "cholesterol -laden foamy histiocytes" 
instead of cholesterol.  
 
(4) The term "true polyp" was mentioned several times. In my opinion, "neoplastic polyp" is a 
better term to describe adenoma  
 
(5) Page10, line1:  
"Mucus contains a macromolecule called mucin, a large -sized glycoprotein, and bile viscosity is 
drastically inc reased by mucus secretion."  
 
Comment: Mucin is not a macromolecule. Instead, mucins are a family of large glycosylated 
proteins.  
 
(6) Page 4, line 16:  
"Premalignant lesions are defined as metaplasia and dysplasia and in most cases, adenoma of the 
gallblad der."  
 
Comment: Metaplasia is not a diagnostic feature of gallbladder adenoma.  
 
Are the methods app ropriate 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.  
 
Yes 
 
Are the conclusi ons drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manus cript or would you recommend an additional 
statistical review?  
If an additional sta tistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable fo r publication unless extensively edited  
 
 
 
 
 
 
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either 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 recei ved reimbursements, fees, funding, or salary from an organization that holds 
or has applied for patents relating 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 have no competing interests  
 
I agree to the open peer review policy of  the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' responses. 
I agree for my report to be made available under an Open Access Creative C ommons 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 named 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: Bile cholesterol and viscosity, the keys to discriminating adenomatous polyps from  
cholesterol polyps by a novel predictive scoring model.  
 
Version: 0 Date: 28 Apr 2020  
 
Reviewer: Chengtang Chiu  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annota ted versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comments to the authors.  
 
(1) The manuscript is not easy to read, as there are many grammatic/syntactic errors or non -
standard English usages that require correction. Significant English language editing, preferably 
by a native speaker, is required to improve the quality of this manuscript. Take the following 
sentences for example.  
 
Page3, line11  
"However, for polyps larger than 10 mm in size, the morphologically distinctive size -based 
classification is limited to accurately distinguishing adenomatous polyps from cholesterol polyps 
that do not require cholecystectomy."  
 
Page 4, line  11  
"The benign polyps were subdivided into cholesterol polyps in most cases and rarely, the non -
cholesterol polyps consisted of adenomyomatosis, hyperplastic polyps, and inflammatory polyps."  
 
Page 10, line 35:  
"The cutoff value of 55 years old is presen ted as a singularity, which is relatively younger than the 
cutoff value commonly mentioned in previous studies."  
 
(3) Page 3, line 16  
"However, cholesterol polyps are generally characterized by cholesterol, a lipid component that is 
very distinct from the  components of adenomatous polyps."  
 
Comment: It seems weird to compare "cholesterol" with "the components of adenomatous polyps", 
which consist of dysplastic epithelial cells. Consider use "cholesterol -laden foamy histiocytes" 
instead of cholesterol.  
 
(4) The term "true polyp" was mentioned several times. In my opinion, "neoplastic polyp" is a 
better term to describe adenoma  
 
(5) Page10, line1:  
"Mucus contains a macromolecule called mucin, a large -sized glycoprotein, and bile viscosity is 
drastically inc reased by mucus secretion."  
 
Comment: Mucin is not a macromolecule. Instead, mucins are a family of large glycosylated 
proteins.  
 
(6) Page 4, line 16:  
"Premalignant lesions are defined as metaplasia and dysplasia and in most cases, adenoma of the 
gallblad der."  
 
Comment: Metaplasia is not a diagnostic feature of gallbladder adenoma.  
 
Are the methods app ropriate 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.  
 
Yes 
 
Are the conclusi ons drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manus cript or would you recommend an additional 
statistical review?  
If an additional sta tistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable fo r publication unless extensively edited  
 
 
 
 
 
 
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either 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 recei ved reimbursements, fees, funding, or salary from an organization that holds 
or has applied for patents relating 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 have no competing interests  
 
I agree to the open peer review policy of  the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' responses. 
I agree for my report to be made available under an Open Access Creative C ommons 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 named 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: Bile cholesterol and viscosity, the keys to discriminating adenomatous polyps from  
cholesterol polyps by a novel predictive scoring model.  
 
Version: 0 Date: 28 Apr 2020  
 
Reviewer: Chengtang Chiu  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annota ted versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comments to the authors.  
 
(1) The manuscript is not easy to read, as there are many grammatic/syntactic errors or non -
standard English usages that require correction. Significant English language editing, preferably 
by a native speaker, is required to improve the quality of this manuscript. Take the following 
sentences for example.  
 
Page3, line11  
"However, for polyps larger than 10 mm in size, the morphologically distinctive size -based 
classification is limited to accurately distinguishing adenomatous polyps from cholesterol polyps 
that do not require cholecystectomy."  
 
Page 4, line  11  
"The benign polyps were subdivided into cholesterol polyps in most cases and rarely, the non -
cholesterol polyps consisted of adenomyomatosis, hyperplastic polyps, and inflammatory polyps."  
 
Page 10, line 35:  
"The cutoff value of 55 years old is presen ted as a singularity, which is relatively younger than the 
cutoff value commonly mentioned in previous studies."  
 
(3) Page 3, line 16  
"However, cholesterol polyps are generally characterized by cholesterol, a lipid component that is 
very distinct from the  components of adenomatous polyps."  
 
Comment: It seems weird to compare "cholesterol" with "the components of adenomatous polyps", 
which consist of dysplastic epithelial cells. Consider use "cholesterol -laden foamy histiocytes" 
instead of cholesterol.  
 
(4) The term "true polyp" was mentioned several times. In my opinion, "neoplastic polyp" is a 
better term to describe adenoma  
 
(5) Page10, line1:  
"Mucus contains a macromolecule called mucin, a large -sized glycoprotein, and bile viscosity is 
drastically inc reased by mucus secretion."  
 
Comment: Mucin is not a macromolecule. Instead, mucins are a family of large glycosylated 
proteins.  
 
(6) Page 4, line 16:  
"Premalignant lesions are defined as metaplasia and dysplasia and in most cases, adenoma of the 
gallblad der."  
 
Comment: Metaplasia is not a diagnostic feature of gallbladder adenoma.  
 
Are the methods app ropriate 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.  
 
Yes 
 
Are the conclusi ons drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manus cript or would you recommend an additional 
statistical review?  
If an additional sta tistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable fo r publication unless extensively edited  
 
 
 
 
 
 
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either 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 recei ved reimbursements, fees, funding, or salary from an organization that holds 
or has applied for patents relating 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 have no competing interests  
 
I agree to the open peer review policy of  the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' responses. 
I agree for my report to be made available under an Open Access Creative C ommons 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 named 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