The issue raised by Dr Assatourians is what is the most informative and safest procedure in a patient who has total bilirubin levels of 32 mg/100 ml; alkaline phosphatase, 215 IU/100 ml; and SGOT, 260 IU/100 ml. This combination of laboratory abnormalities might well be seen in drug jaundice but is certainly compatible with extrahepatic obstruction. Even if there were only a 25% chance that this patient had a dilated biliary tree, I would prefer not to risk bile peritonitis with a liver biopsy. The risks of liver biopsy in patients with obstructive jaundice have been reviewed by Harold Conn, MD, in an editorial ( Gastroenterology 68:817, 1975) and are not negligible. In addition, a liver biopsy cannot always differentiate between extrahepatic and intrahepatic cholectasis. Endoscopic retrograde cholangiopancreatography is a rapid and safe method of visualizing the biliary tract. Our selection of it as our initial diagnostic approach seems