To the Editor.—
Although we agree with Fischer et al that the differentiation of hepatocellular from extrahepatic obstructive (surgical) jaundice is greatly facilitated by ultrasonography and liver biopsy, we disagree on the subsequent approach to the patient with "surgical" jaundice.The diagnosis of pancreatic cancer in a patient with jaundice is of a different nature than the diagnosis of the same disease in a nonicteric patient. The patient with jaundice and dilated biliary ducts will require either surgical or radiological decompression. The use of multiple preoperative investigations outside of ultrasonography to detect the presence of gallstones, dilated biliary ducts, or both and PTC to determine the level of the obstruction is unwarranted in operative candidates. Furthermore, temporary or permanent percutaneous catheter drainage of the bile ducts is possible only via PTC and not ERCP, and such drainage in severly jaundiced patients has been shown to lower operative mortality.1 Since
LiCalzi LK, Storer EH. Diagnosis of Cholestatic Jaundice. JAMA. 1981;246(24):2805. doi:10.1001/jama.1981.03320240015006
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