Review for 10.1186/s12876-016-0479-3 (2016)

Reviewer ’s report  
 
Title: Liver Elasticity Measurement Before and After Biliary Drainage in Patients With  
Obstructive Jaundice -A Prospective Cohort Study  
 
Version: 0 Date: 25 Jan 2016  
 
Reviewer: Kidist Yimam  
 
Reviewer's report:  
This study further confirms previously reported increased liver stiffness in a setting of 
extrahepatic biliary obstruction. Additionally, it showed shortly after biliary drainage, liver 
elasticity as well serum markers of fibrosis (elevated in biliary obstruction) decrease.  
However, the reported correlations between T -Bil, TE, VTQ -L, and VTQ -R are not robust and 
not all clinically sound. T -Bil is shown to correlate better with VTQ -L values than VTQ -R or TE 
values. VTQ -L values tend to be higher than VTQ -R values due to moveme nt of body organs 
near left hepatic lobe and the value does not always reflect a true level of liver elasticity.  In 
addition, the small sample size of this study may limit the ability to define these correlations 
better statistically.  
The authors should also consider evaluating if changes in serum alkaline phosphates correlate 
better with VTQ -L, VTQ -R and TE than T -Bil in their current cohort. In addition to confirming 
the findings of this study in a larger cohort, a future study should aim at defining T -Bil and/or 
ALP cut -off valves that correlate with certain stages of liver elasticity measure by TE and/or 
VTQ in at least "acute" biliary obstruction. In a setting of chronic biliary obstruction, if liver 
elasticity measured by TE/VTQ is elevated more than  anticipated, this can give the clinician 
information on possible hepatic fibrosis as a result of the chronic biliary obstruction. We also 
need to learn if the location of the biliary obstruction has varying effect on the degree of hepatic 
elasticity.  
Addi tional comment: page 7, line 5 needs minor revision.  
Are the methods appropriate and well described?  
If not, pl ease 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.  
 
No 
 
Are the conclusions drawn adequately supported by the da ta shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what a spects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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