Review for 10.1186/s12876-025-04095-4 (2025)

Title: Long-term Quality of Life After Acute Pancreatitis: A Systematic Review and Meta-
Analysis
Version: 1 Date: 21 Apr 2025
Reviewer:  Karunia Valeriani Japar
Reviewer's report:
The manuscript addresses an important topic: the long-term impact of acute pancreatitis (AP) on
patients' quality of life (QoL). A systematic review and meta-analysis are appropriate methods
to synthesize the available evidence. However, there are several areas that need attention to
improve the clarity, rigor, and impact of the study.
Specific Comments
Abstract
Clarity: The abstract is generally clear but could be more concise. Consider reducing the length
slightly to highlight the most critical findings.
Results: In the abstract, specify the range of follow-up duration. This provides important context
for the long-term impact being assessed.
Conclusion: While the conclusion summarizes the impaired QoL domains, it should also briefly
mention the implications of these findings and potential directions for future research, such as
the need for standardized QoL assessment tools.
Introduction
Background: The introduction provides a good overview of AP and its complications. However,
it could benefit from a more focused statement of the research gap.
Rationale: Clearly articulate why this meta-analysis is needed. Mention the inconsistencies in
previous studies and emphasize how this study will contribute to a better understanding of the
impact of AP on QoL.
Objectives: State the specific aims of the study more explicitly. For example, "This study aims
to (1) systematically review the literature on QoL in AP survivors and (2) quantitatively assess
the impact of AP on various QoL domains through meta-analysis."
Methods
Search Strategy: The search strategy appears comprehensive, but it would be helpful to include
the exact search strings used in each database in the supplementary material.
Study Selection: The inclusion and exclusion criteria are well-defined.
Data Extraction: Mention the process used to handle multiple publications from the same study
population to avoid duplication of data.
Quality Assessment: The use of the Newcastle-Ottawa Scale (NOS) is appropriate.
Statistical Analysis:
Specify the method used to handle heterogeneity (e.g., subgroup analysis, sensitivity analysis)
besides using random-effects models.
Explain why publication bias analysis was not conducted, even with a limited number of studies.
A discussion of the potential impact of publication bias should be included.
Results
Study Selection: The flow diagram (Figure 1) should clearly illustrate the number of studies
screened, assessed for eligibility, and included in the systematic review and meta-analysis.
Ensure that the reasons for excluding studies at each stage are transparent.
Basic Characteristics: Table 1 should include more details about the characteristics of the
included studies, such as the diagnostic criteria for AP, the severity of AP (mild, moderate,
severe), and the specific QoL instruments used.
Exocrine and Endocrine Insufficiency: The presentation of data on exocrine and endocrine
insufficiency is somewhat confusing. Clarify whether these results are from the systematic
review or the meta-analysis.
Discussion
Summary of Findings: Start the discussion with a clear and concise summary of the main
findings.
Comparison with Existing Literature: Provide a more in-depth comparison of the findings with
previous studies. Discuss the reasons for any inconsistencies or discrepancies.
Strengths and Limitations: Acknowledge the limitations of the study, such as the heterogeneity
of the included studies, the potential for publication bias, and the reliance on observational
data. Discuss the strengths of the study, such as the comprehensive search strategy and rigorous
quality assessment.
Implications for Clinical Practice and Future Research: Discuss the implications of the findings
for the management of AP patients. Suggest specific areas for future research, such as
the development of targeted interventions to improve QoL in AP survivors and the use of
standardized QoL assessment tools.
Tables and Figures
Table 1: Provide more details about study characteristics.
Table 2: Ensure that all abbreviations are defined in the table footnotes.
Figure 1: Improve the clarity of the flow diagram.
Minor Points
Typos and Grammar: Proofread the manuscript carefully to correct any typos or grammatical
errors.
References: Ensure that all references are accurate and complete.
Recommendations
Address Heterogeneity: Explore potential sources of heterogeneity and conduct subgroup or
sensitivity analyses if possible.
Strengthen Discussion: Provide a more in-depth discussion of the findings in the context of
existing literature and highlight the implications for clinical practice and future research.
Improve Clarity: Ensure that the manuscript is clear, concise, and easy to understand. Pay
attention to the organization of the results section and the presentation of data in tables and
figures.
By addressing these comments, the authors can significantly improve the quality and impact of
their manuscript.