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Barbara B. Frank, MD; David L. Earnest, MD
American Gastroenterological Association Chester, Pa

JAMA. 1990;263(15):2051.

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

In Reply.—

The purpose of practice guidelines is to advise clinicians of the most useful, safe, and cost-effective approach to clinical problems. Such advice should be based on the best evidence available in the literature and, whenever possible, on controlled clinical trials. Dr Morayati takes issue with our guidelines on the clinical evaluation of jaundice in their failure to include cholescintigraphy as a diagnostic modality in patients with jaundice and refers to the reports of Weissmann et al¹ and Pauwels et al² to support his viewpoint.

The article by Weissmann et al provides a lucid but uncontrolled description of cholescintigraphic findings that are suggestive of obstruction in postoperative patients, with no description of methods, no indication that interpretation of the scans was blinded, and no attempt to compare cholescintigraphy with other diagnostic modalities.¹ In the study by Pauwels et al, scans were interpreted by two different observers . . . [Full Text PDF of this Article]

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