To the Editor.—Referring to the article "Spasm and Operative Cholangiography" by Drs. Chessick et al (Arch Surg 110:53, 1975), we are impressed by their use of two techniques that are probably spasmogenic on their own and may result in complications. In patient 3, as noted, a highpressure injection at the time of cholangiography resulted in postoperative pancreatitis. High-pressure injections will also result in spasm of the sphincter of Oddi. Performance of operative and T-tube cholangiograms with gravity technique is preferred to injection, as back pressure in the pancreas may rupture acini and pressure within the hepatic radicals may produce bacteremia. Spasm of the sphincter with pressure injection interferes with interpretation of the cholangiogram.
Second, the use of large-diameter dilators to calibrate the papilla is unnecessary. In case 3, a No. 6 dilator was used and in cases 4 and 6 a No. 7 dilator was used. Calibration of the