Review for 10.1186/s12876-025-03801-6 (2025)

Title: The risk factors affecting effect of extracorporeal shock wave lithotripsy for pancreatic
duct stones
Version: 2 Date: 07 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The introduction mentions several risk factors (e.g., age of onset, BMI, diabetes, smoking) for
pancreatic duct stones but does not explain how these risk factors specifically influence the
success of ESWL. While they are valuable to mention, the introduction could briefly touch on
their potential roles in ESWL treatment outcomes. This would help link the risk factors to the
objective of the study more explicitly.
-While the introduction mentions that ESWL works via shock wave energy, providing a slightly
more detailed explanation of how it impacts stone fragmentation at the cellular level or in
terms of stone composition might help to provide more depth to the explanation of ESWL's
effectiveness.
-The exclusion of patients who did not undergo preoperative CT or had incomplete records
is logical. However, it would be beneficial to briefly explain why these specific criteria were
chosen for exclusion. For instance, if patients without CT scans were excluded, it may be due
to the need for precise stone localization, but this should be stated more explicitly.
-While the post-treatment follow-up procedure is mentioned briefly, more details could be
included regarding the follow-up period. How long were patients monitored after ESWL? Were
there any long-term outcomes, such as recurrence of stones or complications, tracked over a
specific duration?
-While the study describes the grouping of patients, providing some baseline demographic data
for the two groups (e.g., age, sex distribution) could be beneficial for the reader to understand
the sample better and assess the comparability of the two groups.
-The introduction mentions that 95% of pancreatic duct stones are radiopaque, and the methods
specify that only radiopaque stones are included. However, it may be helpful to briefly note
if there were any particular challenges with different types of stone compositions or how the
treatment might vary for radiolucent stones, even though these are not part of the study.
-While the discussion touches on the relationships between stone volume, CT value, sex, and
ESWL success, it could benefit from a more in-depth exploration of the mechanisms behind
these associations. For example:
.How does the sphincter of Oddi dysfunction (especially in women) contribute to poorer
outcomes in ESWL treatment?
.Why does a higher stone CT value correlate with lower ESWL success rates? While the
discussion mentions that higher CT values correspond to harder stones and greater calcium
content, expanding on how this makes fragmentation more difficult from a biochemical or
mechanical perspective would strengthen the explanation.
-The study defines "complete" and "incomplete" lithotripsy based on stone size after treatment.
While the discussion mentions the relationship between stone characteristics and lithotripsy
success, it could expand on the potential reasons for residual stones in the incomplete group. For
instance, does the failure to fragment stem from the physical properties of the stone (hardness,
density), the shock wave energy limitations, or other clinical factors? Offering more insights
into why these patients required more treatments could help clarify how these characteristics
specifically contribute to treatment failure.