CHARLES SAFRAN, M.D.; ROBERT A. GREENES, M.D., PH.D.; TURNER E. BYNUM, M.D.
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To the editor: The article by Richter and associates (1) on the analysis of diagnostic strategies in suspected obstructive jaundice is deficient in two major ways. First, this analysis ignores the significant published mortality of both transhepatic cholangiography (2, 3) and endoscopic retrograde cholangiopancreatography (2, 4, 5). What would be the average cost of these techniques to the patient if physicians valued the life of the patient in every 1000 who dies from the invasive imaging techniques?
Secondly, the authors have confused diagnosis with outcome. Clearly the diagnosis of advance malignancy causing extrahepatic obstruction leads to a different outcome than
SAFRAN C, GREENES RA, BYNUM TE. Diagnostic Strategy for Obstructive Jaundice. Ann Intern Med. ;99:571–572. doi: 10.7326/0003-4819-99-4-571_3
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Published: Ann Intern Med. 1983;99(4):571-572.
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