Title: Pilot feasibility study to determine the utility of direct access and quantitative magnetic
resonance cholangiopancreatography (MRCP) in the assessment of suspected acute biliary or
ductal gallstone presentations.
Version: 2 Date: 10 Nov 2024
Reviewer:  Toshio Tsuyuguchi
Reviewer's report:
This is an interesting paper showing the results of RCT, but the number of cases included is small
and the results of imaging and clinical diagnosis are difficult to understand. The paper advocates
the superiority of the direct MRCP group in terms of cost and time, but the results of imaging
and clinical diagnosis should be clearly presented before proceeding with the discussion.
#1. ALP is preferable to GGT for biochemical testing in suspected cholangitis. Biochemical tests
such as WBC and CRP, which indicate an inflammatory response, are necessary to differentiate
cholecystitis or cholangitis from gallstone colic pain.
#2. In Figure 1, 276 of 305 patients were excluded because they did not meet the inclusion
criteria. In this study, about 90% of the cases were excluded. How many of the 276 cases included
those who required emergency ERCP or surgery or those who were admitted to the ICU, which
are exclusion criteria?
#3. The MRCP shows a diagnosis of gallstones in 8 out of 11 cases, but there is no mention of
common bile duct stones or gallbladder stones. The authors also mention 5 common bile duct
stones out of 27 cases in the discussion, but these are not mentioned in the results.
#4. Due to the small number of cases included, no comparison was made between quantitative
MRCP and traditional MRCP. In general, gallbladder enlargement and bile duct diameter alone
are not sufficient to diagnose cholelithiasis, and authors must provide evidence, historical data,
and citations.
Title: Pilot feasibility study to determine the utility of direct access and quantitative magnetic
resonance cholangiopancreatography (MRCP) in the assessment of suspected acute biliary or
ductal gallstone presentations.
Version: 2 Date: 10 Nov 2024
Reviewer:  Toshio Tsuyuguchi
Reviewer's report:
This is an interesting paper showing the results of RCT, but the number of cases included is small
and the results of imaging and clinical diagnosis are difficult to understand. The paper advocates
the superiority of the direct MRCP group in terms of cost and time, but the results of imaging
and clinical diagnosis should be clearly presented before proceeding with the discussion.
#1. ALP is preferable to GGT for biochemical testing in suspected cholangitis. Biochemical tests
such as WBC and CRP, which indicate an inflammatory response, are necessary to differentiate
cholecystitis or cholangitis from gallstone colic pain.
#2. In Figure 1, 276 of 305 patients were excluded because they did not meet the inclusion
criteria. In this study, about 90% of the cases were excluded. How many of the 276 cases included
those who required emergency ERCP or surgery or those who were admitted to the ICU, which
are exclusion criteria?
#3. The MRCP shows a diagnosis of gallstones in 8 out of 11 cases, but there is no mention of
common bile duct stones or gallbladder stones. The authors also mention 5 common bile duct
stones out of 27 cases in the discussion, but these are not mentioned in the results.
#4. Due to the small number of cases included, no comparison was made between quantitative
MRCP and traditional MRCP. In general, gallbladder enlargement and bile duct diameter alone
are not sufficient to diagnose cholelithiasis, and authors must provide evidence, historical data,
and citations.
Please review this paper.
user
Title: Pilot feasibility study to determine the utility of direct access and quantitative magnetic
resonance cholangiopancreatography (MRCP) in the assessment of suspected acute biliary or
ductal gallstone presentations.
Version: 2 Date: 10 Nov 2024
Reviewer:  Toshio Tsuyuguchi
Reviewer's report:
This is an interesting paper showing the results of RCT, but the number of cases included is small
and the results of imaging and clinical diagnosis are difficult to understand. The paper advocates
the superiority of the direct MRCP group in terms of cost and time, but the results of imaging
and clinical diagnosis should be clearly presented before proceeding with the discussion.
#1. ALP is preferable to GGT for biochemical testing in suspected cholangitis. Biochemical tests
such as WBC and CRP, which indicate an inflammatory response, are necessary to differentiate
cholecystitis or cholangitis from gallstone colic pain.
#2. In Figure 1, 276 of 305 patients were excluded because they did not meet the inclusion
criteria. In this study, about 90% of the cases were excluded. How many of the 276 cases included
those who required emergency ERCP or surgery or those who were admitted to the ICU, which
are exclusion criteria?
#3. The MRCP shows a diagnosis of gallstones in 8 out of 11 cases, but there is no mention of
common bile duct stones or gallbladder stones. The authors also mention 5 common bile duct
stones out of 27 cases in the discussion, but these are not mentioned in the results.
#4. Due to the small number of cases included, no comparison was made between quantitative
MRCP and traditional MRCP. In general, gallbladder enlargement and bile duct diameter alone
are not sufficient to diagnose cholelithiasis, and authors must provide evidence, historical data,
and citations.
assistant