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

Muhammad F. Dawwas, MRCP; Asif Jah, FRCS; William J. H. Griffiths, MRCP, PhD; Andrew P. Winterbottom, FRCR; Emmanuel L. Huguet, FRCS, PhD; Alexander E. Gimson, FRCP
Arch Surg. 2011;146(11):1336-1337. doi:10.1001/archsurg.2011.304.
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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

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Correspondence

November 1, 2011
John Maa, MD
Arch Surg. 2011;146(11):1336-1337. doi:10.1001/archsurg.2011.303.
November 1, 2011
David Flook, MCh, MRCS; Bilal Alkhaffaf, FRCS; Edward Parkin, FRCS
Arch Surg. 2011;146(11):1336-1337. doi:10.1001/archsurg.2011.305.
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