Is MRCP worthwhile when ERCP is planned? A prospective trial in a referral center

D. A. Devonshire, A. V. Sahai, K. G. Yeoh, C. Kay, D. Feldman, H. Tang, P. Tarnasky, John T Cunningham, R. H. Hawes, P. B. Cotton

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Abstract

AIMS: 1) Does magnetic resonance cholangiopancreatography (MRCP) add to ERCP? 2) Does MRCP narrow the differential diagnosis (DDx) and/or obviate the need for diagnostic (Dx) and/or therapeutic (Rx) ERCP?. METHODS: All new patients (pts) referred to our pancreato-biliary service, in whom ERCP was planned, also underwent MRCP when available. PART 1 (DOES MRCP ADD TO ERCP?): Attendings performed ERCP while blinded to MRCP. They assigned pre and post-test probabilities for pre-specified differential diagnoses (6 possible per context) before and after ERCP and then after the MRCP result was received (reported) on standardized form by 1 of 2 radiologists + films available). PART 2 (DOES MRCP REDUCE THE DDx AND/OR PREVENT ERCP?): For each pt, conclusions were made by another attending who was aware of the complete history (Hx) + MRCP, but blinded to ERCP results. At each step, physicians also rated the need for Dx and Rx ERCP as: Indicated / Unsure / No. RESULTS: 40 pts studied to date (study ongoing). Mean age 52,±16; 53% female. Contexts: Abnormal liver enzymes 29%; suspected chronic pancreatitis 26%; pre or post cholecystectomy pain 18%; recurrent acute pancreatitis 16%; jaundice 11%. PART 1: Adding MRCP to ERCP did not reduce the # DDx significantly (mean # DDx: without MRCP 1.7±0.9 vs after adding MRCP 1.4±0.6; p=0.09); and would have prevented no Rx ERCPs. PART 2: Using MRCP alone (without ERCP information) reduced the mean # DDx; but less so than using ERCP alone (mean reduction in DDx: Hx+ERCP -1.1±1.2 vs Hx+MRCP -0.6±1.0; p=0.06). MRCP would have prevented no Dx ERCPs and only 1/40(3%) of Rx ERCPs. PART 1 PART 2 ERCP type Dx Rx Dx Rx ERCP needed? U No U No U No U No (U-unsure) After history only 10% 0% 82% 0% 10% 0% 68% 0% Dx ERCP information added - - 23% 10% - - - - MRCP information added - - 20% 10% 7% 0% 45% 3% The results did not change significantly after stratifying by the perceived need for sphincter of Oddi (SO) manometry or by clinical context. CONCLUSIONS: When ERCP is planned at our tertiary referral center, adding MRCP to ERCP does not reduce the # DDx and does not prevent Dx or Rx ERCP. MRCP alone narrows the DDx (but less so than Dx ERCP), but prevents no Dx ERCP and <5% of Rx ERCPs. These results appear unrelated to the need for SO manometry. These preliminary findings need exploration in different patient groups and practice settings.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume47
Issue number4
Publication statusPublished - 1998
Externally publishedYes

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ASJC Scopus subject areas

  • Gastroenterology

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Devonshire, D. A., Sahai, A. V., Yeoh, K. G., Kay, C., Feldman, D., Tang, H., ... Cotton, P. B. (1998). Is MRCP worthwhile when ERCP is planned? A prospective trial in a referral center. Gastrointestinal Endoscopy, 47(4).