To the editor: Ransohoff and associates (1), in their article on management of the patient with silent gallstones, use decision analysis and conclude that "prophylactic cholecystectomy should not be routinely recommended" because it "slightly decreases survival. "
The approach of the authors, although praiseworthy, is incomplete because it neglects the third strategy for management of silent gallstones—medical dissolution. Medical dissolution is free of mortality and has a success rate of 30% to 80% for radiolucent gallstones in patients who ingest an adequate dosage of chenodiol or ursodiol, its 7β epimer (2).
The initial cost of drug treatment, including monitoring costs,
Silent Gallstones. Ann Intern Med. ;99:876–877. doi: 10.7326/0003-4819-99-6-876
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Published: Ann Intern Med. 1983;99(6):876-877.
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