The decision-making value of magnetic resonance cholangiopancreatography in patients seen in a referral center for suspected biliary and pancreatic disease

Anand V. Sahai, David Devonshire, Khay G. Yeoh, Clive Kay, David Feldman, Ira Willner, Joshua Farber, Rig Patel, Paul R. Tarnasky, John T Cunningham, Thadeus Trus, Robert H. Hawes, Peter B. Cotton

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

OBJECTIVE: To assess the ability of MRCP to alter the differential diagnosis and to prevent diagnostic and/or therapeutic ERCP. The diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) for biliary and pancreatic disease is well documented. Some believe MRCP may prevent diagnostic ERCP or add useful information, however there are no reports of its impact on clinical management. METHODS: Consecutive patients referred for ERCP underwent clinic evaluation, then MRCP, and then ERCP. In Phase 1, the number of differential diagnoses and the perceived need for diagnostic ERCP were evaluated after each step by the endoscopist who performed the ERCP. In Phase 2, the process was repeated after presenting clinical information and MRCP results to different individual physicians: another endoscopist, a hepatologist, a radiologist, and a surgeon (all were blinded to ERCP results). RESULTS: Forty patients were enrolled. Clinical contexts were jaundice (19.7%), abnormal liver enzymes (42.6%), abdominal pain (11.5%), recurrent acute pancreatitis (11.5%), and suspected complications of chronic pancreatitis (14.7%). In Phase 1, adding MRCP information to diagnostic ERCP information did not change the mean number of differential diagnoses significantly and prevented no therapeutic ERCP. In Phase 2, adding MRCP to clinical information only (without ERCP) reduced the differential diagnosis significantly for the radiologist and the surgeon only and would have prevented ≤3% of diagnostic and therapeutic ERCP for all physicians. CONCLUSION: The value of MRCP information may be limited if patient selection is inappropriate and may differ in physicians depending on their speciality.

Original languageEnglish (US)
Pages (from-to)2074-2080
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume96
Issue number7
DOIs
StatePublished - 2001
Externally publishedYes

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Magnetic Resonance Cholangiopancreatography
Pancreatic Diseases
Endoscopic Retrograde Cholangiopancreatography
Decision Making
Referral and Consultation
Differential Diagnosis
Physicians
Aptitude
Chronic Pancreatitis
Jaundice
Pancreatitis
Abdominal Pain
Patient Selection
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The decision-making value of magnetic resonance cholangiopancreatography in patients seen in a referral center for suspected biliary and pancreatic disease. / Sahai, Anand V.; Devonshire, David; Yeoh, Khay G.; Kay, Clive; Feldman, David; Willner, Ira; Farber, Joshua; Patel, Rig; Tarnasky, Paul R.; Cunningham, John T; Trus, Thadeus; Hawes, Robert H.; Cotton, Peter B.

In: American Journal of Gastroenterology, Vol. 96, No. 7, 2001, p. 2074-2080.

Research output: Contribution to journalArticle

Sahai, AV, Devonshire, D, Yeoh, KG, Kay, C, Feldman, D, Willner, I, Farber, J, Patel, R, Tarnasky, PR, Cunningham, JT, Trus, T, Hawes, RH & Cotton, PB 2001, 'The decision-making value of magnetic resonance cholangiopancreatography in patients seen in a referral center for suspected biliary and pancreatic disease', American Journal of Gastroenterology, vol. 96, no. 7, pp. 2074-2080. https://doi.org/10.1016/S0002-9270(01)02528-X
Sahai, Anand V. ; Devonshire, David ; Yeoh, Khay G. ; Kay, Clive ; Feldman, David ; Willner, Ira ; Farber, Joshua ; Patel, Rig ; Tarnasky, Paul R. ; Cunningham, John T ; Trus, Thadeus ; Hawes, Robert H. ; Cotton, Peter B. / The decision-making value of magnetic resonance cholangiopancreatography in patients seen in a referral center for suspected biliary and pancreatic disease. In: American Journal of Gastroenterology. 2001 ; Vol. 96, No. 7. pp. 2074-2080.
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abstract = "OBJECTIVE: To assess the ability of MRCP to alter the differential diagnosis and to prevent diagnostic and/or therapeutic ERCP. The diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) for biliary and pancreatic disease is well documented. Some believe MRCP may prevent diagnostic ERCP or add useful information, however there are no reports of its impact on clinical management. METHODS: Consecutive patients referred for ERCP underwent clinic evaluation, then MRCP, and then ERCP. In Phase 1, the number of differential diagnoses and the perceived need for diagnostic ERCP were evaluated after each step by the endoscopist who performed the ERCP. In Phase 2, the process was repeated after presenting clinical information and MRCP results to different individual physicians: another endoscopist, a hepatologist, a radiologist, and a surgeon (all were blinded to ERCP results). RESULTS: Forty patients were enrolled. Clinical contexts were jaundice (19.7{\%}), abnormal liver enzymes (42.6{\%}), abdominal pain (11.5{\%}), recurrent acute pancreatitis (11.5{\%}), and suspected complications of chronic pancreatitis (14.7{\%}). In Phase 1, adding MRCP information to diagnostic ERCP information did not change the mean number of differential diagnoses significantly and prevented no therapeutic ERCP. In Phase 2, adding MRCP to clinical information only (without ERCP) reduced the differential diagnosis significantly for the radiologist and the surgeon only and would have prevented ≤3{\%} of diagnostic and therapeutic ERCP for all physicians. CONCLUSION: The value of MRCP information may be limited if patient selection is inappropriate and may differ in physicians depending on their speciality.",
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T1 - The decision-making value of magnetic resonance cholangiopancreatography in patients seen in a referral center for suspected biliary and pancreatic disease

AU - Sahai, Anand V.

AU - Devonshire, David

AU - Yeoh, Khay G.

AU - Kay, Clive

AU - Feldman, David

AU - Willner, Ira

AU - Farber, Joshua

AU - Patel, Rig

AU - Tarnasky, Paul R.

AU - Cunningham, John T

AU - Trus, Thadeus

AU - Hawes, Robert H.

AU - Cotton, Peter B.

PY - 2001

Y1 - 2001

N2 - OBJECTIVE: To assess the ability of MRCP to alter the differential diagnosis and to prevent diagnostic and/or therapeutic ERCP. The diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) for biliary and pancreatic disease is well documented. Some believe MRCP may prevent diagnostic ERCP or add useful information, however there are no reports of its impact on clinical management. METHODS: Consecutive patients referred for ERCP underwent clinic evaluation, then MRCP, and then ERCP. In Phase 1, the number of differential diagnoses and the perceived need for diagnostic ERCP were evaluated after each step by the endoscopist who performed the ERCP. In Phase 2, the process was repeated after presenting clinical information and MRCP results to different individual physicians: another endoscopist, a hepatologist, a radiologist, and a surgeon (all were blinded to ERCP results). RESULTS: Forty patients were enrolled. Clinical contexts were jaundice (19.7%), abnormal liver enzymes (42.6%), abdominal pain (11.5%), recurrent acute pancreatitis (11.5%), and suspected complications of chronic pancreatitis (14.7%). In Phase 1, adding MRCP information to diagnostic ERCP information did not change the mean number of differential diagnoses significantly and prevented no therapeutic ERCP. In Phase 2, adding MRCP to clinical information only (without ERCP) reduced the differential diagnosis significantly for the radiologist and the surgeon only and would have prevented ≤3% of diagnostic and therapeutic ERCP for all physicians. CONCLUSION: The value of MRCP information may be limited if patient selection is inappropriate and may differ in physicians depending on their speciality.

AB - OBJECTIVE: To assess the ability of MRCP to alter the differential diagnosis and to prevent diagnostic and/or therapeutic ERCP. The diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) for biliary and pancreatic disease is well documented. Some believe MRCP may prevent diagnostic ERCP or add useful information, however there are no reports of its impact on clinical management. METHODS: Consecutive patients referred for ERCP underwent clinic evaluation, then MRCP, and then ERCP. In Phase 1, the number of differential diagnoses and the perceived need for diagnostic ERCP were evaluated after each step by the endoscopist who performed the ERCP. In Phase 2, the process was repeated after presenting clinical information and MRCP results to different individual physicians: another endoscopist, a hepatologist, a radiologist, and a surgeon (all were blinded to ERCP results). RESULTS: Forty patients were enrolled. Clinical contexts were jaundice (19.7%), abnormal liver enzymes (42.6%), abdominal pain (11.5%), recurrent acute pancreatitis (11.5%), and suspected complications of chronic pancreatitis (14.7%). In Phase 1, adding MRCP information to diagnostic ERCP information did not change the mean number of differential diagnoses significantly and prevented no therapeutic ERCP. In Phase 2, adding MRCP to clinical information only (without ERCP) reduced the differential diagnosis significantly for the radiologist and the surgeon only and would have prevented ≤3% of diagnostic and therapeutic ERCP for all physicians. CONCLUSION: The value of MRCP information may be limited if patient selection is inappropriate and may differ in physicians depending on their speciality.

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