Oyón D, Velamazán R, Arnau A, López-Guillén P, Martínez-Domínguez SJ, Abad Baroja D, Ruiz-Belmonte LM, Tejedor-Tejada J, Zapater R, Martín-Vicente N, Julián Gomara AB, Sastre Lozano V, Manzanares García JJ, Cañamares-Orbis P, García-Rayado G, Millastre Bocos J, Garcia de Paredes AG, Vaamonde Lorenzo M, Izagirre Arostegi A, Sirtl S, de-Madaria E. Recurrence patterns and outcomes of symptomatic gallstone disease in the elderly. World J Gastroenterol 2026; 32(21): 117971 [DOI: 10.3748/wjg.v32.i21.117971]
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07483717
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June 10, 2026, 07:45
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Reader Comments:
This multicenter post hoc analysis of the RELAPSTONE cohort focused on a special patient group. Symptomatic gallstone disease (SGD) recurs in patients aged ≥80 years who are not operated on at the index admission. Its principal strengths are the large size. It has reportedly the largest cohort of patients ≥80 years with SGD. It also has a multicenter design, and has a contemporary age threshold (80 year) that reflects current life expectancy better than the conventional cutoff of 65. The observation that recurrences in the elderly are fewer but later and more severe, with acute cholecystitis most common, is clinically useful and clearly presented.
My suggestions which aim to improve this and other such studies are as follows.
First, death is an important competing event for recurrence and is considerably more frequent in the ≥80 group, yet the study was analysed with standard Kaplan–Meier and Cox models. Patients who die can no longer experience a recurrence, and mortality differs substantially between groups. Cumulative incidence function for recurrence with death as a competing event combined with Fine–Gray subdistribution hazards would yield a more accurate estimate of the actual probability of recurrence in each age group. Reporting the proportions censored because of death and end of follow-up would also clarify the analysis.
Second, the molecular mechanism underlying SGD warrant further study and elucidation. Whereas elderly people recur in a more severe manner, their overall state and comorbidity limit the use of cholecystectomy. Developing oral or transfusion drugs would benefit this group of patient who are more often influenced by worse symptoms.
Overall this is a valuable contribution that should help refine risk stratification in an important and growing population, and the comments above are intended to strengthen an already solid study.
Reader's ID:
02997239
Submitted on:
May 29, 2026, 15:43
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Reader Comment Standards for Published Articles:
1 Title
Does the title reflect the main subject/hypothesis of the manuscript?
2 Abstract
Does the abstract summarize and reflect the work described in the manuscript?
3 Key Words
Do the key words reflect the focus of the manuscript?
4 Background
Does the manuscript adequately describe the background, present status and significance of the study?
5 Methods
Does the manuscript describe methods (e.g., experiments, data analysis, surveys, and clinical trials, etc.) in adequate detail?
6 Results
Are the research objectives achieved by the experiments used in this study?
Has the study made meaningful contributions towards research progress in this field?
7 Discussion
Does the manuscript interpret the findings adequately and appropriately, highlighting the key points concisely, clearly and logically?
Are the findings and their applicability/relevance to the literature stated in a clear and definite manner?
Is the Discussion accurate and does it discuss the paper’s scientific significance and/or relevance to clinical practice sufficiently?
8 Illustrations and Tables
Are the figures, diagrams and tables sufficient, good quality and appropriately illustrative of the paper contents?
Do figures require labeling with arrows, asterisks, etc., or better legends?
9 Biostatistics
Does the manuscript meet the requirements of biostatistics?
10 Units
Does the manuscript meet the requirements of use of SI units?
11 References
Does the manuscript appropriately cite the latest, important and authoritative references in the Introduction and Discussion sections?
Does the author self-cite, omit, incorrectly cite and/or over-cite references?
12 Quality of manuscript organization and presentation
Is the manuscript concisely and coherently organized and presented?
Are the style, language and grammar accurate and appropriate?
13 Ethics statements
For all manuscripts involving human studies and/or animal experiments, author(s) must submit the related formal ethics documents that were reviewed and approved by their local ethical review committee. Did the manuscript meet the requirements of ethics?
Scientific Quality:
The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories
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Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.
Reader Comments:
it is better to investigate the role of other factors as diabetes; hypertension; body mass index ; fatty liver disease in gall stone complications.
dietary habits have a significant impact on pathogenesis of gall stone complications. so that a questionnaire of diet intake should be done to investigate the effect of different food staff on symptoms and complications of gall stone disease.