We agree with Drs LiCalzi and Storer that jaundiced patients with dilated biliary ducts require either surgical or radiological decompression. We have no quarrel with those who chose to follow our algorithm along the path where PTC follows when dilated ducts are demonstrated by sonography. The algorithm expresses our preference for this route when sonography shows only intrahepatic duct dilation.Certainly decompression by temporary PTC catheter drainage can be advantageous in very ill, deeply jaundiced patients, and permanent endobiliary decompression is a viable alternative treatment for the elderly or proved unresectable patient. However, they are incorrect in their impression that this cannot be accomplished via the ERCP route; it has been done.1,2We emphatically disagree that the diagnosis of ampullary or pancreatic head carcinoma is best made at the time of surgery. At the Lahey Clinic the operative diagnosis of carcinoma of the pancreatic head was later
Fischer MG, Gelb AM, Weingarten LA. Diagnosis of Cholestatic Jaundice-Reply. JAMA. 1981;246(24):2805–2806. doi:10.1001/jama.1981.03320240015007
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