Review for 10.1186/s12876-024-03145-7 (2024)

Title: Early encapsulation of peripancreatic fluid/necrosis collections on imaging (CECT) in
acute pancreatitis: influential factors and clinical significance for prognosis
Version: 1 Date: 31 Aug 2023
Reviewer:  Dóra Illés
Reviewer's report:
The reviewed article „Early encapsualtion pf peri-pancreatic fluid/necrosis collections on
imaging (CETC) in acute pancreatitis: influential factors and clinical significance of prognosis”
aims to determine the time interval needed to form a continuous enhancing wall around the
inflamed tissue and the prognostical role of this phenomenon.
Although acute pancreatitis is one of the most frequent GI diseases needed hospital admission,
its severity assessment in the early stage is still a challenge during the all-day practice, therefore
the topic of the article is relevant.
The article needs a thorough supervision concerning the use of english language. For example:
„prognosis significance” is an inadequate term.
The numbers in table 2 have been misplaced.
In general, details of methods and data collections are not totally clarified in this article.
From 1308 AP patients only 289 had CECT 4 to 10 days from the onset of the symptoms. What
is the indication of a CECT in this interval? What is the cause of that 725 patients with AP did
not have a CECT during this time period?
Figure 3 shows the ratio of early encapsulation seen on CECT on different days after the onset
of symptoms. The calculation of this percentage is unclear. Does it show the rate of the early
encapsulation by the whole examined population (289 patients) or by the patients who had CECT
on the given day? How many patients from 289 had CECT on the 4th,5th…etc. day? Is there
anyone who had CECT more times during this period? I asssume that not everyone from the
289 AP patients had CECT daily during the 5 days period. Please publish the number of CECT
done on a given day and de number of scans that showed early encapsulation.
Table 1 shows that the time from onset to CECT examination was significantly longer among
the patients with early encapsulation. Please, explain and discuss this finding.
Alanine aminotransferase, total bilirubin and creatinine showed significant difference between
the early/non-encapsulatied groups. In table 1, median values are publicated. What are the
normal ranges for these variables? Concerning the level of ALAT, 23.5 and 17.5 U/L are still
normal? If yes, please explain the clinincal significane of this finding.
The early registered APACHEII scores show significant difference between the examined
groups. However, the median, significance-showing values are 8 and 7.5. Please, explain the
applicability of this finding during the all-day practice.
Concerning the outcomes of the 2 examined subgroups (table 3): the rate of infected pancreatic
necrosis was higher among the patients with early encapsulated inflammation. In the discussion
you mentioned that the encapsulated wall could not impede the translocation of bacteria.
However it does not explain the significant difference between the 2 groups. Could you give
an explanation of this finding? How was the infection diagnosed? However, the rate of infected
necrosis was twice as high in the early group, there is no statistical significance between the
groups.
You constantly state that encapsulation is an important sign for surgical interventions
(percutaneous drainage or open abdominal debridement) but there is nothing about endoscopical
interventions of the late local consequences of AP (pseudocyst or WON) although these are
preferred over open or minimally invasive surgery. Please explain this.
The rate of surgical interventions was higher in the „early encapsulation” group. What kind of
interventions were needed and what was the indication of these?
As a summary, the topic of this article is relevant and there is an important finding in it (the time
elapses until formation of immature wall). However, in this recent format I do not suggest its
publication, a major revision is needed.