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Dai D. Nghiem, MD
The University of Iowa Hospitals and Clinics Iowa City

JAMA. 1984;251(1):40.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Dr Venu and colleagues have to be congratulated for their excellent skill in performing ERCP with a 95% success in demonstrating the common bile duct, while most endoscopists obtain only 70% success. They also have to be commended for having only 0.5% pancreatitis v the 7.4% rate from a previous survey.¹

The amount of time spent to cannulate and inject the pancreatic ducts and the whole biliary tree, the radiation exposure for both patients and observers, and the cost of the entire procedure do not seem to be justified, since only 13.1% of the patients studied are identified to have cholelithiasis confirmed by operation.

Recognizing that "symptoms suggestive of biliary tract disease" can also be caused by such factors as cholesterolosis, adenomyomatosis, cystic duct obstruction, and even pancreatic disease before its classic radiological features are present, the demonstration of "lithogenic bile" described first by Lyon² . . . [Full Text PDF of this Article]

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