We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Gallstone Size and Risk for Pancreatitis

Andrew K. Diehl, MD, MSc
Arch Intern Med. 1998;158(5):543-544. doi:.
Text Size: A A A
Published online


In reply

Cohen has highlighted the uncertainties of ascribing risk based on findings from cross-sectional studies. A more valid estimate of the risk for pancreatitis among patients with gallstones of varying size must come from prospective cohort studies.

Nevertheless, our findings have implications for the treatment of patients after a first episode of uncomplicated biliary pain. Ransohoff and Gracie's1 1993 decision analysis compared expectant management with prophylactic cholecystectomy in patients with symptoms of gallstones. Their model demonstrated that a 50-year-old woman gains 104 days to her life expectancy with early surgery. This gain is greater than that predicted for many widely accepted preventive interventions, such as cervical cancer screening every 3 years from ages 20 to 75 years (96 days added to the life expectancy), breast cancer screening with annual physical examination and mammography for 10 years beginning at age 50 years (45 days added to the life expectancy), or reduction in serum cholesterol levels from 6.2 to 5.8 mmol/L (240 to 224 mg/dL) in a 40-year-old man (30 days added to the life expectancy).2 Furthermore, because death due to gallstone disease is uncommon, the major factor guiding patient treatment should be the prevention of morbidity. Approximately 6% to 10% of unselected patients with symptomatic gallstones have recurrent symptoms annually, and 2% develop biliary complications.3 Given the likely higher risk for morbidity due to pancreatitis in patients with small gallstones, a decision for expectant management in that subgroup seems particularly ill-advised.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





March 9, 1998
Andrew K. Diehl, MD, MSc
Arch Intern Med. 1998;158(5):543-544. doi:.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Environmental risk factors for pancreatic cancer: an update. Arch Toxicol Published online Aug 18, 2016;