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January 13, 1984

Management of Cholelithiasis-Reply

Author Affiliations

Gastroenterology Consultants, Ltd Racine, Wis

JAMA. 1984;251(2):218. doi:10.1001/jama.1984.03340260026019

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In Reply.—  The case reported by Dr McKenzie is of a 24-year-old woman who had recurrent biliary colic secondary to choledocholithiasis that could only be diagnosed by laparotomy. Although our article dealt with gallbladder stones diagnosed only by ERCP, the clinical situation described by Dr McKenzie is similar to the problem that we have dealt with.Based on our experience on the usefulness of ERCP in demonstrating small stones in the common bile duct, we would like to reemphasize that roentgenographic technique and the concentration of the contrast material used are extremely important because small stones could easily be missed.We disagree with Dr McKenzie in recommending exploratory laparotomy for patients with biliary colic as a diagnostic and therapeutic approach. This is supported by our small but incomplete data on two of the seven patients (group 1) who had no stones detected by ERCP examination and who underwent exploratory laparotomy