The increase in the incidence of choledochal cysts has increased due to increase in pickup
rate can be attributed to better detection by means of advanced technology. The iIncidence ofthese cysts in Asia is somewhat higher than that in western countries. The reason for thisgeographical difference is still remains unclear. There is also an unexplained female

Comment [A1]: Comparing items without using aparallel structure may create confusion. Here, thesentence is revised for clear and accurate comparisonas “the incidence” in two geographical regions isbeing compared.

preponderance with These cysts are more common in female patients—the female: -to-maleratio is commonly reported as 4:1. However, the reason for this is unknown. With regard toetiology, tThe most widely accepted hypothesis regarding etiology is involves an anomalous
arrangement of the pancreaticobiliary ductal junction. The triad of jaundice, right upper
quadrant pain, and a palpable subcostal mass is diagnostic, but it is not seen present in allcases.

Comment [A2]: In American English, a comma(called as a serial comma) is generally added before“and” in a series.

Choledochal cysts can be associatedmay appear in patients with biliary atresia, congenital
hepatic fibrosis, and renal cystic disease of the kidney, especially renal tubular ectasia,
sometimes in combinedation with cortical and medullary cysts. Reported complications ofcCholedochal cysts include have been reported to cause complications such as secondary
calculus formation, pancreatitis, biliary cirrhosis, cyst rupture with bile peritonitis,
cholangitis, intrahepatic abscess, and portal vein thrombosis. Moreover, such cysts may
rupture, causing bile peritonitis, and they have the potential for malignant transformation into
cholangiocarcinoma.

Ultrasonography is the preferred for method for initial evaluation. It reveals depicts
choledochal cyst as an anechoic cystic structure separate from the gall bladder that
communicates with the hepatic ducts. The dDifferential diagnosies, which is based on ultra
sound findings, includes other fluid- filled structures in this region, namely pancreatic
pseudocysts, large right renal cysts, enteric duplication cysts, and hepatic artery aneurysms.
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Comment [A3]: The text alongside has been rearranged such that the sentence is divided into twoparts. This has avoided an excessively lengthy
sentence and has helped in a better flow of ideas sothat all the potential complications related tocholedochal cysts can be understood clearly.

Hepatobiliary scintigraphy can also complement the diagnosis by showings late accumulationof radioisotope in the cystic structure, which further supports the diagnosis.

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Comment [A4]: Some singular nouns refer to one
specific thing (the only one of its kind) andtherefore, "the" is placed before the noun. Here,“the” is therefore added to denote specificity.