LAUSR

To the Editor, We thank the writers for their letter regarding our paper, ‘‘Predicting Success in Percutaneous Transhepatic Biliary Drainage.’’ As stated in our paper, we agree that percutaneous transhepatic biliary drainage (PTBD) often results in decreased bilirubin levels [1] and our findings match those of the referenced papers [2–5]. However, our paper examines the efficacy of PTBD in achieving a goal of a particular bilirubin level. For our study, we evaluated achieving levels less than 2 mg/dL as this is required for many chemotherapeutic regimens. The data suggest that certain patient populations are less likely to achieve a bilirubin less than 2 mg/dL despite successful PTBD placement. This does not mean that PTBD should no longer be performed nor do we doubt its efficacy in certain clinical settings. It is our hope that information on the likely decrease in bilirubin post-PTBD will allow patients and referring providers to better weigh the risks and benefits of the procedure. We agree with the letter writers that further studies are needed and data from other institutions to make the model more robust. Compliance with Ethical Standards