Patient satisfaction after MRCP and ERCP

OBJECTIVE: Magnetic resonance cholangiopancreatography (MRCP) is an accurat e diagnostic test for detecting abnormalities of the pancreaticobiliary sys tem. Because it is noninvasive, MRCP appears to be more tolerable than ERCP , although this has not been studied. The purpose of this study is to compa re patient satisfaction after MRCP and ERCP performed sequentially. METHODS: We prospectively recruited 34 patients undergoing ERCP, for whom a n MRCP was able to be performed before ERCP. Patient satisfaction was asses sed by validated questionnaires using seven-point Likhert scales (individua l ratings and direct comparisons). The following dimensions were explored: anxiety, pain, discomfort, tolerability (relative to expectations), willing ness to repeat the procedure, and overall preference. chi (2) and Student's t tests (paired and unpaired) were performed, and 95% CIs were provided. RESULTS: Two patients (5.9%) were unable to undergo MRCP because of claustr ophobia. The remaining 32 completed both tests (94% same day) and all quest ionnaires. Average age was 56 +/- 18 yr, and 66% were women. In 23 patients , some degree of biliary obstruction was suspected; nine patients had pancr eatitis. Patients reported, a lower degree of pain (p < 0.001) and discomfo rt (p = 0.047) with MRCP, but MRCP was more difficult than they expected (p = 0.012). Patients were marginally more willing to repeat MRCP (ns, p = 0. 09). On direct comparisons, patients were more satisfied with MRCP regardin g anxiety (p = 0.04) and pain (p = 0.001). Patients displayed a higher over all preference for MRCP compared with ERCP (p = 0.01); however, only 59% cl early preferred MRCP over ERCP. The most common problem with MRCP was claus trophobia or noise (n = 15), and the differences were more striking in the subgroup without this problem. The subgroup undergoing purely diagnostic ER CPs showed clear preferences Sor MRCP. CONCLUSIONS: In many respects, MRCP is well tolerated, and certain subgroup s, especially those undergoing diagnostic ERCPs, prefer MRCP over ERCP. As an endoscopist, one needs to be aware of the limitations of MRCP and relay these to the patient, as it seems that patients find MRCP more difficult th an anticipated, and a significant number still prefer ERCP over MRCP. Patie nt satisfaction may be fur ther improved by reducing noise and claustrophob ia with selective premedication, earplugs, and the use of the new quieter f enestrated magnetic resonance imaging scanners. (Am J Gastroenterol 2001;96 :2646-2650. (C) 2001 by Am. Coll. of Gastroenterology).