Title: "Evaluation of Hepatobiliary Disorders Using Magnetic Resonance
Cholangiopancreatography in a Low-Resource Setting in Kano,Nigeria: A Retrospective Study"
Version: 2 Date: 17 Jan 2025
Reviewer:  Alaa Ismail
Reviewer's report:
First, this paper is a good contribution to literature, particularly in its application in a resource-
limited setting to highlight the impact of MRCP in the diagnosis and management of biliary
disorders and avoid unnecessary invasive ERCP. The authors’ efforts to explore the local
horizons of the status quo of MRCP utilization are appreciated. This retrospective analysis
investigates and provides valuable insights into the diagnostic and clinical utility of MRCP and
highlights its potential to enhance hepatobiliary and pancreatic disease management in Kano,
Nigeria. The study design is solid, and the methodology is appropriate for the research question.
The statistical analysis is sound, and the findings are generally well-supported by the data.
However, I have some comments to address:
1. Please note that it is stated in the declaration of Helsinki that when a potential research subject
who is deemed incapable of giving informed consent is able to give assent to decisions about
participation in research, the physician must seek that assent in addition to the consent of the
legally authorized representative. The potential subject’s dissent should be respected. As such,
we ask that in your ‘Ethics approval and consent to participate’ section, to clarify whether assent
to participate was obtained from minor participants capable of understanding the study's purpose
and their involvement.
2. The sample size of 101 patients is relatively small for drawing conclusions, posing the risk
of poor generalizability. However, this sample size might be sufficient for preliminary findings.
Perhaps power analysis could strengthen the manuscript's validity.
3. The manuscript will benefit from expanding the discussion section to include a brief
discussion about how MRCP findings influenced clinical decision-making or patient outcomes.
4. The study would benefit from a more detailed comparison between MRCP and ERCP,
particularly in terms of their respective strengths and weaknesses to help readers understand
why MRCP is a preferred choice in certain clinical scenarios in Nigeria.
5.  The study would benefit from highlighting the limitations of MRCP, including the limited
availability of MRCP machines or expertise, inability to biopsy, limited visualization of certain
areas due to bowel gas or patient movement, or the potential imaging artifacts that may hinder
proper diagnosis.
6. The authors reference several studies that found gender differences in biliary diseases, such as
higher rates of cholelithiasis in women. However, the manuscript could provide more discussion
on why no significant gender differences were found in this study, potentially addressing
hormonal or genetic factors influencing gender-specific disease patterns.
7. The manuscript mentions the retrospective nature of the study and its potential biases;
however, there is limited discussion on the specific imitations of the study design.
8. The manuscript would benefit from a section discussing potential areas for future research.
For example, recommending future research to provide strong empirical evidence regarding
the causal relationship in multicenter studies in similar resource-limited settings would greatly
enhance the academic value of this paper.
9. The overall language of the article needs to be revised.
Overall, the article is of good value to literature. With some revisions and additional
contextualization, the manuscript has the potential to offer valuable insights into both clinicians
and researchers in the field of radiology and hepatobiliary diseases.
Title: "Evaluation of Hepatobiliary Disorders Using Magnetic Resonance
Cholangiopancreatography in a Low-Resource Setting in Kano,Nigeria: A Retrospective Study"
Version: 2 Date: 17 Jan 2025
Reviewer:  Alaa Ismail
Reviewer's report:
First, this paper is a good contribution to literature, particularly in its application in a resource-
limited setting to highlight the impact of MRCP in the diagnosis and management of biliary
disorders and avoid unnecessary invasive ERCP. The authors’ efforts to explore the local
horizons of the status quo of MRCP utilization are appreciated. This retrospective analysis
investigates and provides valuable insights into the diagnostic and clinical utility of MRCP and
highlights its potential to enhance hepatobiliary and pancreatic disease management in Kano,
Nigeria. The study design is solid, and the methodology is appropriate for the research question.
The statistical analysis is sound, and the findings are generally well-supported by the data.
However, I have some comments to address:
1. Please note that it is stated in the declaration of Helsinki that when a potential research subject
who is deemed incapable of giving informed consent is able to give assent to decisions about
participation in research, the physician must seek that assent in addition to the consent of the
legally authorized representative. The potential subject’s dissent should be respected. As such,
we ask that in your ‘Ethics approval and consent to participate’ section, to clarify whether assent
to participate was obtained from minor participants capable of understanding the study's purpose
and their involvement.
2. The sample size of 101 patients is relatively small for drawing conclusions, posing the risk
of poor generalizability. However, this sample size might be sufficient for preliminary findings.
Perhaps power analysis could strengthen the manuscript's validity.
3. The manuscript will benefit from expanding the discussion section to include a brief
discussion about how MRCP findings influenced clinical decision-making or patient outcomes.
4. The study would benefit from a more detailed comparison between MRCP and ERCP,
particularly in terms of their respective strengths and weaknesses to help readers understand
why MRCP is a preferred choice in certain clinical scenarios in Nigeria.
5.  The study would benefit from highlighting the limitations of MRCP, including the limited
availability of MRCP machines or expertise, inability to biopsy, limited visualization of certain
areas due to bowel gas or patient movement, or the potential imaging artifacts that may hinder
proper diagnosis.
6. The authors reference several studies that found gender differences in biliary diseases, such as
higher rates of cholelithiasis in women. However, the manuscript could provide more discussion
on why no significant gender differences were found in this study, potentially addressing
hormonal or genetic factors influencing gender-specific disease patterns.
7. The manuscript mentions the retrospective nature of the study and its potential biases;
however, there is limited discussion on the specific imitations of the study design.
8. The manuscript would benefit from a section discussing potential areas for future research.
For example, recommending future research to provide strong empirical evidence regarding
the causal relationship in multicenter studies in similar resource-limited settings would greatly
enhance the academic value of this paper.
9. The overall language of the article needs to be revised.
Overall, the article is of good value to literature. With some revisions and additional
contextualization, the manuscript has the potential to offer valuable insights into both clinicians
and researchers in the field of radiology and hepatobiliary diseases.
Please review this paper.
user
Title: "Evaluation of Hepatobiliary Disorders Using Magnetic Resonance
Cholangiopancreatography in a Low-Resource Setting in Kano,Nigeria: A Retrospective Study"
Version: 2 Date: 17 Jan 2025
Reviewer:  Alaa Ismail
Reviewer's report:
First, this paper is a good contribution to literature, particularly in its application in a resource-
limited setting to highlight the impact of MRCP in the diagnosis and management of biliary
disorders and avoid unnecessary invasive ERCP. The authors’ efforts to explore the local
horizons of the status quo of MRCP utilization are appreciated. This retrospective analysis
investigates and provides valuable insights into the diagnostic and clinical utility of MRCP and
highlights its potential to enhance hepatobiliary and pancreatic disease management in Kano,
Nigeria. The study design is solid, and the methodology is appropriate for the research question.
The statistical analysis is sound, and the findings are generally well-supported by the data.
However, I have some comments to address:
1. Please note that it is stated in the declaration of Helsinki that when a potential research subject
who is deemed incapable of giving informed consent is able to give assent to decisions about
participation in research, the physician must seek that assent in addition to the consent of the
legally authorized representative. The potential subject’s dissent should be respected. As such,
we ask that in your ‘Ethics approval and consent to participate’ section, to clarify whether assent
to participate was obtained from minor participants capable of understanding the study's purpose
and their involvement.
2. The sample size of 101 patients is relatively small for drawing conclusions, posing the risk
of poor generalizability. However, this sample size might be sufficient for preliminary findings.
Perhaps power analysis could strengthen the manuscript's validity.
3. The manuscript will benefit from expanding the discussion section to include a brief
discussion about how MRCP findings influenced clinical decision-making or patient outcomes.
4. The study would benefit from a more detailed comparison between MRCP and ERCP,
particularly in terms of their respective strengths and weaknesses to help readers understand
why MRCP is a preferred choice in certain clinical scenarios in Nigeria.
5.  The study would benefit from highlighting the limitations of MRCP, including the limited
availability of MRCP machines or expertise, inability to biopsy, limited visualization of certain
areas due to bowel gas or patient movement, or the potential imaging artifacts that may hinder
proper diagnosis.
6. The authors reference several studies that found gender differences in biliary diseases, such as
higher rates of cholelithiasis in women. However, the manuscript could provide more discussion
on why no significant gender differences were found in this study, potentially addressing
hormonal or genetic factors influencing gender-specific disease patterns.
7. The manuscript mentions the retrospective nature of the study and its potential biases;
however, there is limited discussion on the specific imitations of the study design.
8. The manuscript would benefit from a section discussing potential areas for future research.
For example, recommending future research to provide strong empirical evidence regarding
the causal relationship in multicenter studies in similar resource-limited settings would greatly
enhance the academic value of this paper.
9. The overall language of the article needs to be revised.
Overall, the article is of good value to literature. With some revisions and additional
contextualization, the manuscript has the potential to offer valuable insights into both clinicians
and researchers in the field of radiology and hepatobiliary diseases.
assistant