Article was disappointing

doi:10.1136/bmj.39311.453600.3A

BMJ 2007;335:362 (25 August), doi:10.1136/bmj.39311.453600.3A

Letters

Gallstones

Article was disappointing

The first 150 words of the full text of this article appear below.

Sanders and Kingsnorth gave a less than comprehensive view oftheir subject.¹ Really important gallstones that must be dealtwith occur in the bile ducts. Where is the discussion aboutdiagnosis with magnetic resonance imaging and computed tomography,management with therapeutic endoscopic retrograde cholangiopancreatography,the place of open surgery, and discussion of optimal antibiotictherapy of ascending cholangitis in 2007?

Of course more cholecystectomies are done in the United States(population 290 million) than in England (population 49 million).The interesting thing is that the rate per head of populationis much greater in the financially driven healthcare systemin the US compared with our public service ethos. The prevalenceof gallstones is probably the same.

Andy Warhol died at 58 after apparently routine surgery forgallstones. Surely death is the most serious complication ofoperative treatment. Gallbladder gallstones are no more likelyto kill patients than the low mortality . . . [Full text of this article]

M C Bateson, consultant physician/gastroenterologist

Bishop Auckland General Hospital, County Durham DL14 6AD

malcolm.bateson@cddft.nhs.uk