Review for 10.1186/s12876-015-0368-1 (2015)

Reviewer's report
Title:Long-term follow-up of nonoperated patients with symptomatic gallbladder
stones : A retrospective study
Version:2Date:15 July 2015
Reviewer: Anu Behari
Reviewer's report:
1. The authors have a specific and well-defined query-whether measurement of
gallbladder ejection fraction by Hepatobiliary scanning can help define the
subgroup of patients with gallstones and minimal/vague symptoms who are more
likely to develop early recurrence of symptoms. The methods are described
simply and the data appears sound. The discussion is quite balanced and
well-supported by the results of the study and the authors understand and clearly
mention the weaknesses of their study.
2. Major Essential Revisions: None
3. Minor Essential Revisions:
The use of the words “recurrent symptom-free rate” and “recurrent symptom-free
period” throughout the manuscript (lines 8, 18, 19, 60, 108,109, 136,275) is
rather confusing and somewhat self-contradictory. The word recurrent suggests
recurrence of symptoms while the word symptom-free suggests the opposite and
the use of the two together becomes difficult to interpret. Also the words “rate”
and “period” seem to have been used inter-changeably though the corresponding
values are always in percentage. In the abstract the period is mentioned as being
shorter and in the text as longer.
The same confusion persists in Figure 1 and its legend- “ Figure 1 Sym ptom
-free recurrence rates. G B, gallbladder; G BEF, gallbladder ejection fraction; H
B, hepatobiliary.” From the figure it can be made out that at 10 years only 19.8%
of patients with GBEF <30% were symptom-free compared to 81.9% of patients
with GBEF>30%. The authors express it as “ For these patients, the 10-year
recurrent symptom-free period was significantly longer than those with a GBEF #
30% (81.9 vs. 19.8%; P < 0.001) (Figure 1).” It is not clear whether by “for these
patients” they mean patients with GBEF <30% or all patients. The figure would
suggest that it is for all the patients but the text would suggest otherwise. Also,
the same values are used but the description in the abstract says “ In patients
with non-visualization of the gallbladder or GBEF <30%, the ten-year recurrent
symptom-free period was significantly shorter than those with a GBEF # 30%
(81.9 20 vs. 19.8%; P < 0.001).” The reader is further confused when in the
discussion the authors state that “the 10-year recurrent symptom-free rate was
significantly higher in patients with GBEF # 30% compared to those with GBEF <
30%.”
I think it would be simpler to just use “symptom-free” rather than “recurrent
symptom-free” , use either “rate” or “period” and to use all these uniformly.
4. Discretionary Revisions: Although the abstract is accurate in conveying the
results of the study and the authors’ conclusion, I feel the title does not convey
that the study is about evaluating the role of Hepatobiliary scans in predicting
early symptom recurrence in patients with gallstones. I would suggest “Long-term
follow-up of non-operated patients with symptomatic gallbladder stones : A
retrospective study evaluating the role of Hepatobiliary scanning”
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests