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

OBJECTIVE: To assess the ability of MRCP to alter the differential diagnosi s and to prevent diagnostic and/or therapeutic ERCP. The diagnostic accurac y of magnetic resonance cholangiopancreatography (MRCP) for biliary and pan creatic disease is well documented. Some believe MRCP may prevent diagnosti c ERCP or add useful information, however there are no reports of its impac t 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 repe ated after presenting clinical information and MRCP results to different in dividual physicians: another endoscopist, a hepatologist, a radiologist, an d 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 acut e pancreatitis (11.5%), and suspected complications of chronic pancreatitis (14.7%). In Phase I, adding MRCP information to diagnostic ERCP informatio n did not change the mean: number of differential diagnoses significantly a nd-prevented no therapeutic ERCP. In Phase 2, adding MRCP to clinical infor mation only (without ERCP) reduced the differential diagnosis significantly for the radiologist and the surgeon only and would have prevented less tha n or equal to3% of diagnostic and therapeutic ERCP for all physicians. CONCLUSION: The value: of MRCP information may be limited if patient select ion is inappropriate and may differ in physicians depending on their specia lity.