Review for 10.1186/s12876-025-03590-y (2025)

Title: Endoscopic retrograde cholangiopancreatography combined with extracorporeal shock
wave lithotripsy for the removal of large gallbladder stones: a pilot study
Version: 1 Date: 13 Oct 2024
Reviewer:  Amira A A Othman
Reviewer's report:
First of all
I want to congratulate the authors on their work. In this study, Zhu et al aim to evaluate
the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in combination with
Endoscopic Retrograde Cholangiopancreatography (ERCP) for the removal of large gallbladder
stones.
Extracorporeal shock wave lithotripsy (ESWL) was first introduced in the 1980s for the
fragmentation of renal and ureteric calculi *. Its application was quickly extended to include
large biliary and pancreatic calculi. Extraction of large gallbladder calculi has always challenged
the therapeutic endoscopist. Extracorporeal shockwave lithotripsy (ESWL) is an excellent tool
for patients with large calculi that are not amenable to routine endotherapy **.
(*: doi.org/10.1016/S0022-5347(17)53841-0, ** doi: 10.3748/wjg.v17.i39.4365).
The authors tried to contribute to this field of research with new findings, nevertheless, there is
an observation for which sufficient justification must be obtained.
In general:
1. The English writing level is shallow, and it is necessary to seek help from an English language
specialist to correct spelling and grammatical errors in the entire text.
2. Abbreviations must be fully written at their first appearance.
In Abstract section
3. The background subsection should be the shortest part of the abstract. It should briefly outline
the following information: What is already known about the subject, related to the paper in
question. What is not known about the subject and hence what the study intended to examine
(or what the paper seeks to present). Please reconstruct it properly.
4. In method:
-Nothing was mentioned about the participant’s age, sex, ethnicity, etc.
- It would help if you described the aim of your statistical analysis.
5. The last two parts of an abstract are the results and the conclusions. You should include the
results that reflect the most important parts of your findings. You do not need to squeeze in every
detail of these results, and it's best to focus clearly on your most significant findings, without
any future directions.
In the Introduction section:
6. Cholecystolithiasis refers to the formation of solid calculi in gallbladder bile. Gallstones that
develop in the gallbladder are classified as cholesterol stones (if >50% cholesterol) or “black”
pigment stones (predominantly polymerized calcium bilirubinate if <30% cholesterol).
7. Authors must give a proper account of gallstones, one of the most prevalent digestive system
disorders in the world, the symptoms if present, the risk factors, the affection % in the American
and Chinese population, etc.
(doi.org/10.3389/fnut.2024.1428488 ).
8.  Cholecystectomy is surgery to remove your gallbladder. It is the only treatment option to
cure symptomatic gallstones. Laparoscopic cholecystectomy is the most common procedure
instead of a traditional, open procedure. Cholecystectomy is the treatment of choice for both
uncomplicated symptomatic cholelithiasis and proven gallbladder sludge with characteristic
biliary pain (doi:10.7326/0003-4819-101-2-171)
In the Methods section:
9. Statistical analysis:
- Why did not you choose mean ± standard error instead of mean ± standard deviation?
-   The Mann–Whitney U test is a nonparametric test and involves the summation of ranks. The
Mann–Whitney U test is applied to independent samples. T-test is used to compare the mean of
a continuous variable between a maximum of 2 groups. The Kruskal–Wallis test is a statistical
test used to compare two or more groups for a continuous or discrete variable. The Wilcoxon
rank-sum test is used to compare two independent samples, while the Wilcoxon signed-rank
test is used to compare two related samples, matched samples, or to conduct a paired difference
test of repeated measurements on a single sample to assess whether their population mean ranks
differ. How did you choose the proper test during your result analysis?
In the Results section:
10. In Tables 3:
-You can title the statistical test column as “Test of significance” and use U= for the Mann–
Whitney U test, T= for the T-test, etc.
In the Discussion section:
11. The discussion section is one of the final parts of a research paper, in which an author
describes, analyzes, and interprets their findings. They explain the significance of those results
and tie everything back to the research question(s). In this manuscript, there is confusion between
what should be written in the introduction section and the discussion section. Please reconstruct
the discussion section.
12. The bias associated with using a self-reported outcome variable was not mentioned by the
authors. Since the majority of gallstones are clinically silent, it is possible to incorrectly diagnose
someone as having or not having gallstones. Results could get skewed as a result.
13. The discussion should explain how gallstones can be managed.
14. What is the novelty of your study in comparison to an old study:
Fauzi, Achmad, et al. "Serial Cases of Combining ESWL and ERCP Procedures in Management
Chronic Pancreatitis and Difficult Bile Duct Stones." Indonesian Journal of Gastroenterology,
Hepatology, and Digestive Endoscopy 10.3 (2009): 131-135.
In the conclusion section:
15. The conclusion should restate your main points and provide closure.