The potential impact of high-equality MRI of the biliary tree on ERCP workload

Background Magnetic resonance cholangiography (MRC) is a non-invasive metho d of imaging the biliary tree with virtually no morbidity, Endoscopic retro grade cholangiopancreatography (ERCP) has a significant morbidity, mortalit y and failed imaging rate. Unlike MRC, ERCP is highly dependent on the clin ical team for high-quality results and minimal morbidity. MRC requires high -quality image acquisition and appropriate reconstructions, with skilled re ading of the images. Objectives To assess the impact on ERCP workload of using MRC as the initia l imaging modality for the biliary tree in selected patient groups, and to assess procedure-related morbidity and mortality. Methods An analysis of 1078 consecutive ERCP examinations performed at our institution over the six years to 1996 has been undertaken. Complications, imaging failure rates and ERCP findings have been analysed in the different referral categories to assess the potential impact of MRC on future ERCP w orkload and patient outcomes. Results At our institution, if MRC had been used as the first imaging inves tigation in patients with abdominal pain (n = 336, with or without abnormal liver function tests but without clinical jaundice) and those with present or past acute pancreatitis (n = 101), we estimate that 83 (19%) would have needed to go on to ERCP, but 354 (81%) would not have required further inv asive investigation. In these categories, this would have resulted in five patients with stones missed at MRC, but 14 extra patients with stones would have been identified whose stones would have been missed at ERCP (failed e xaminations). There would be an overall 33% reduction in ERCP workload and 20 serious complications related to ERCP would have been avoided. Overall 7 % of patients would be subjected to both investigations. Conclusions In the interests of efficient use of resources, minimization of patient complications and accurate identification of those requiring thera peutic ERCP, MRC should be the preferred initial investigation in selected groups of patients presently being subjected to ERCP. Eur J Gastroenterol H epatol 12:773-776 (C) 2000 Lippincott Williams & Wilkins.