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April 1979

Operative Cholangiography and Overlooked Stones-Reply

Author Affiliations

Lexington, Mass

Arch Surg. 1979;114(4):549. doi:10.1001/archsurg.1979.01370280203036

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In Reply.–We appreciate that choledochoscopy is a uniquely satisfying means of evaluating the larger ductal system. We refer to its use in the "Comment" section of our article, noting that "choledochoscopy, where available, can be more appropriately directed to... suspicious defects." The problem lies in availability. Of the three hospitals in the study, teaching hospitals in the metropolis of Boston, only one has a choledochoscope. One of the three hospitals has recently rejected purchase of the instrument, citing an unfavorable cost-benefit ratio as the reason. We suspect that the instrument is not available in many institutions. In today's legal and regulatory climate, we wonder if it is wise to recommend in print, and thus sanctify as the norm, a technique that is not yet in the hands of the rank and file. Let us for now work to improve good cholangiographic techniques that are familiar to us all.

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