Title: Identification of changes in bile composition in pancreaticobiliary reflux based on liquid
chromatography/mass spectrometry metabolomics
Version: 1 Date: 01 Oct 2023
Reviewer's report:
Thank you for giving me an opportunity to review this article. The non-targeted metabolomic
analysis of bile in PBR patients was very interesting. However, I have concerns about this study.
There are two main problems, one concerning the diagnostic criteria for PBR and the other a
logical jump.
Comments
#1
The authors used normal plasma amylase levels as a reference, and bile amylase levels higher
than the normal plasma amylase levels as indicative of PBR. However, I have a concern about
the diagnostic criteria for PBR. The status of pancreatic juice reflux in patients with PBR is
still unclear. For example, whether the reflux of pancreatic juice is persistent or transient, and
whether there is a difference in the amount of reflux flow compared to the pancreaticobiliary
maljunction. Thus, the authors' diagnostic criteria for PBR appear to be inadequate. At the very
least, the serum amylase levels and bile amylase values of the present patients should be clearly
stated. It would need to be clearly stated in the text rather than in the supplemental data.
#2
To what extent were the bile amylase levels elevated in the PBR group? Were there any cutoff
values of the bile amylase level for diagnosis of PBR?
#3
Was there any intraoperative cholangiography or other means to confirm the phenomenon of
PBR?
#4
The authors attempted to explore the mechanism of PBR by the non-targeted metabolomic
analysis of bile in patients with PBR. In addition, the authors aimed to explore the mechanism
of gallstone formation in patients with PBR in the present study. However, the results of this
study only revealed differences in bile metabolites between the PBR and control groups. It is
not possible to draw the above conclusions from these results.
The above conclusion can only be drawn by calculating and comparing the percentages of
patients without gallstones and those with gallstones in the PBR patients and healthy subjects,
respectively.
#5
Is it possible that true pancreaticobiliary maljunction has been included? Although the authors
excluded the pancreaticobiliary maljunction in this study, I wonder if the preoperative imaging
studies were performed correctly.
Title: Identification of changes in bile composition in pancreaticobiliary reflux based on liquid
chromatography/mass spectrometry metabolomics
Version: 1 Date: 01 Oct 2023
Reviewer's report:
Thank you for giving me an opportunity to review this article. The non-targeted metabolomic
analysis of bile in PBR patients was very interesting. However, I have concerns about this study.
There are two main problems, one concerning the diagnostic criteria for PBR and the other a
logical jump.
Comments
#1
The authors used normal plasma amylase levels as a reference, and bile amylase levels higher
than the normal plasma amylase levels as indicative of PBR. However, I have a concern about
the diagnostic criteria for PBR. The status of pancreatic juice reflux in patients with PBR is
still unclear. For example, whether the reflux of pancreatic juice is persistent or transient, and
whether there is a difference in the amount of reflux flow compared to the pancreaticobiliary
maljunction. Thus, the authors' diagnostic criteria for PBR appear to be inadequate. At the very
least, the serum amylase levels and bile amylase values of the present patients should be clearly
stated. It would need to be clearly stated in the text rather than in the supplemental data.
#2
To what extent were the bile amylase levels elevated in the PBR group? Were there any cutoff
values of the bile amylase level for diagnosis of PBR?
#3
Was there any intraoperative cholangiography or other means to confirm the phenomenon of
PBR?
#4
The authors attempted to explore the mechanism of PBR by the non-targeted metabolomic
analysis of bile in patients with PBR. In addition, the authors aimed to explore the mechanism
of gallstone formation in patients with PBR in the present study. However, the results of this
study only revealed differences in bile metabolites between the PBR and control groups. It is
not possible to draw the above conclusions from these results.
The above conclusion can only be drawn by calculating and comparing the percentages of
patients without gallstones and those with gallstones in the PBR patients and healthy subjects,
respectively.
#5
Is it possible that true pancreaticobiliary maljunction has been included? Although the authors
excluded the pancreaticobiliary maljunction in this study, I wonder if the preoperative imaging
studies were performed correctly.
Please review this paper.
user
Title: Identification of changes in bile composition in pancreaticobiliary reflux based on liquid
chromatography/mass spectrometry metabolomics
Version: 1 Date: 01 Oct 2023
Reviewer's report:
Thank you for giving me an opportunity to review this article. The non-targeted metabolomic
analysis of bile in PBR patients was very interesting. However, I have concerns about this study.
There are two main problems, one concerning the diagnostic criteria for PBR and the other a
logical jump.
Comments
#1
The authors used normal plasma amylase levels as a reference, and bile amylase levels higher
than the normal plasma amylase levels as indicative of PBR. However, I have a concern about
the diagnostic criteria for PBR. The status of pancreatic juice reflux in patients with PBR is
still unclear. For example, whether the reflux of pancreatic juice is persistent or transient, and
whether there is a difference in the amount of reflux flow compared to the pancreaticobiliary
maljunction. Thus, the authors' diagnostic criteria for PBR appear to be inadequate. At the very
least, the serum amylase levels and bile amylase values of the present patients should be clearly
stated. It would need to be clearly stated in the text rather than in the supplemental data.
#2
To what extent were the bile amylase levels elevated in the PBR group? Were there any cutoff
values of the bile amylase level for diagnosis of PBR?
#3
Was there any intraoperative cholangiography or other means to confirm the phenomenon of
PBR?
#4
The authors attempted to explore the mechanism of PBR by the non-targeted metabolomic
analysis of bile in patients with PBR. In addition, the authors aimed to explore the mechanism
of gallstone formation in patients with PBR in the present study. However, the results of this
study only revealed differences in bile metabolites between the PBR and control groups. It is
not possible to draw the above conclusions from these results.
The above conclusion can only be drawn by calculating and comparing the percentages of
patients without gallstones and those with gallstones in the PBR patients and healthy subjects,
respectively.
#5
Is it possible that true pancreaticobiliary maljunction has been included? Although the authors
excluded the pancreaticobiliary maljunction in this study, I wonder if the preoperative imaging
studies were performed correctly.
assistant