Review for 10.1186/s12876-021-01842-1 (2021)

Reviewer’s report
Title: 
Pancreaticopleural Fistula in a Child with Chronic Pancreatitis Harboring
Compound SPINK1 Variants
Version: 
1 
Date: 
18 Mar 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
No - there are minor issues
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: What is your overall impression of the report? 
Though extremely rare, there have been few reported cases. This report stresses
two things 1. Treatment of a PPF and 2. The fact that it should stimulate the
evaluation of the patients esp a child for a pancreatic genomic mutation which
will be important to the family and his/her offspring
Are you confident in the authors' description and interpretation of the report? 
I have made many suggestions to more precisely and specifically describe the
findings. Somewhere in the text the authors should mention that figure 3 really
shows a posterior mediastinal 
pseudocyst that ruptured into the right pleural
cavity and functioned as a PPF
Have the authors clearly outlined the need for publication by novelty of the case
or the specific adverse event? 
Yes I believe so for the reasons I outlined above in impression- teaching case cc
treatment and diagnosis
REQUESTED REVISIONS: 
Suggested changes
P-LEASE NORTE I 
HAEBV 
MADE MANY SUIGGESTIONS BUT THEY
ARE ALL C0NSRUCTIVE
1. In the future, Please either number 
your pages or number the lines
progressively across all pages 
this will make any correspondence with the
journal or the peer reviewers easier for everyone
2. 
Page 1 abstract( I will refer to the pages after this 
order) 
Line 13 ( your
numbers) delete "manifested" change to "who presents with a "
3.page 1 line 22 best to explain what endoscopic treatment you did 
4. Page 1 line 26 add at the end of the sentence. "in an appropriate clinical
situation related to pancreatic pathology" 
5. Page 1 lines 17 and 29 when you say "conservative treatment" what do you
mean? Just observation or TPN, NPO, etc 
6. Page 1 conclusions. 
This is too long, shorten some of this- you have already
said above
7. Page 2 line 7 add also "acute necrotizing pancreatitis" as a potential cause
8 page 2 line 18 why not refer to the specific pediatric 
cases in the literature refs
8,9,11, and 15?
9. Page 2 lines 14 and 32 and page 3 line 21 
delete the word "scan" 
tomography
is a "scan"
10. Page 3 line 1 add the word "chain of lakes" after the word 
" dilatations" also
"dilations" would be more correct than dilatations
11. Page 3 line 12 is there any evidence that antioxidants have any role on
treatment? If so I would add a reference to support this treatment; I know of no
good data on this! 
Also was he sent home in oral feeding or was the TPN and the
octreotide continued ? Were there any restrictions on types of food intake? Did
you consider enteral feeding distal to duodenum? 
Need to explain all this
12 page 3 line 23 was he also put on TPN?
13. page 3 line 24 and 28 change to "ERP" 
no need to inject the bile duct
14 figure 2 need to label a and b, 
15. Figure 3. Need to label the panels. 
I cannot be convinced that the arrow
shows the PPF track-- it does show a mediastinal fluid collection 
but this
collection is nowhere near the pancreas on this scan. The track to this posterior
mediastinal pseudocyst 
is further caudal I suggest that you consider this fluid
collection as a mediastinal pseudocyst that ruptured into the right pleural space. 
16. 
Figure 4 I do not see a stricture 
in the PD just after the neck of the gland on
the duodenal side even though that is where it usually is and should be in this
patient 
17. Page3 Lines26 and 27 did you have to dilate the PD structure?
18. Page 4 line 2 I do not understand the sentence. What do you mean by a
discrepancy? Do you mean that only 4 to 40% of families of a patient with a
SPINK 1 mutation have an identifiable family history?
19. Page 4 line 6 the disruption is not always "posterior" 
Delete the word 
20. Page 4 line 14. Liver cirrhosis ? Really? That is unlikely and especially when
the increase in amylase activity 
is so great! I would delete that reference to liver
cirrhosis in fact I would delete the rest of the entire sentence starting 
on line 12
these other causes are really really rare
21 page 4 lines 19 and 29. Quite frankly I think that you mean not "the fistula"
but rather the "pseudocyst"-- in truth most PPFs are small in diameter
22. Page 4 line 29 please add the references
23. Page 4 line 30 what type of complications? Add them briefly so anyone
planning this can be aware of these complications 
24. Page 4 line 31 I would add after the word "management" the following
phrase "such as pancreatic resection or formal operative pancreatic ductal
drainage procedures"
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