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To the Editor The randomized clinical trial (RCT) by Dr Iranmanesh and colleagues1 compared 2 commonly used clinical strategies for the evaluation of suspected choledocholithiasis in patients at intermediate risk and found that initial cholecystectomy, compared with sequential endoscopy and surgery, decreased the length of stay and number of common duct investigations. We believe that the results of this study, and their implications, should be considered in the context of 2 important caveats.
Elmunzer BJ, Cote GA, Rockey DC. Treatment for Patients at Intermediate Risk of a Common Duct Stone. JAMA. 2014;312(19):2043. doi:10.1001/jama.2014.13419