April 18, 1990

Cholescintigraphy in the Evaluation of Jaundice

Author Affiliations

Newark, Del

Newark, Del

JAMA. 1990;263(15):2050-2051. doi:10.1001/jama.1990.03440150054021

To the Editor.—  I read with interest the recent article on the clinical evaluation of jaundice by Dr Frank and members of the Patient Care Committee of the American Gastroenterological Association.1 The authors reviewed accurately the usefulness of noninvasive studies, including ultrasonography and computed tomographic scan, in the assessment of jaundice. However, the value of cholescintigraphy as an adjunct noninvasive study and in selected cases as the modality of choice in screening patients was overlooked.Ultrasound is poor at detecting common bile duct stones; not all obstructed ducts are dilated and not all dilated ducts are functionally obstructed, especially after cholecystectomy,2,3 and therefore cholescintigraphy can play a major role in the diagnosis of obstructed jaundice. Its overall accuracy is reported to be about 96% to 97%.4 Cholescintigraphy has a distinct advantage in patients in whom choledocholithiasis is considered to be the most likely cause (eg, acute