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April 18, 1990

Cholescintigraphy in the Evaluation of Jaundice-Reply

Author Affiliations

American Gastroenterological Association Chester, Pa

American Gastroenterological Association Chester, Pa

JAMA. 1990;263(15):2051. doi:10.1001/jama.1990.03440150054022

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