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Nov 2011

Emerging Trends in Endoscopic Retrograde Cholangiopancreatography and Common Bile Duct Exploration—Reply

Author Affiliations

Author Affiliations: Cambridge Hepatobiliary Service (Drs Dawwas, Jah, Griffiths, Huguet, and Gimson), and Department of Radiology (Dr Winterbottom), Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.

Arch Surg. 2011;146(11):1336-1337. doi:10.1001/archsurg.2011.304

In reply

We thank Dr Maa for his comments regarding our report. Although bile duct exploration is undeniably a well-established treatment modality for choledocholithiasis (not least when endoscopic therapy has failed), we did not feel that it would be an appropriate management option in our case for a number of reasons.

First, our patient was an 89-year-old man with significant comorbidities, including ischemic heart disease, diabetes mellitus, and a 9-cm abdominal aortic aneurysm, for whom the risks of biliary surgery were considerable and further accentuated by the possibility of postoperative aneurysm rupture.1