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January 6, 1984

Diagnosis of Cholelithiasis

JAMA. 1984;251(1):39. doi:10.1001/jama.1984.03340250023011

To the Editor.—  In the article entitled "Endoscopic Retrograde Cholangiopancreatography" (1983;249:758), Venu and co-workers contend that those patients with symptoms suggestive of cholelithiasis and abnormal liver function test results should have an endoscopic retrograde cholangiopancreatography (ERCP) examination despite normal oral cholecystogram and sonograms of the gallbladder. This study was based on a retrospective analysis of patients examined between 1975 and 1980. Of the 206 patients examined, only 30 had real-time ultrasonography. Of these, three patients, or 10%, had false-negative results. A 10% false-negative rate with real-time ultrasound is no longer an acceptable figure. It is interesting that of the 29 patients who did have gallstones at ERCP or cholecystectomy, only three were missed by real-time ultrasound, leaving the other 26 false-negative results caused by either oral cholecystography or static sonography. I agree with the results of Cooperberg and Burhenne1 recording a specificity of about 95% in the diagnosis of