The Role of Magnetic Resonance Cholangiopancreatography in the Diagnosis of Choledocholithiasis: Do Benefits Outweigh the Costs?

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in evaluation of the biliary tree for choledocholithiasis. Formal indications for magnetic resonance cholangiopancreatography (MRCP) in suspected choledocholithiasis are lacking. Our objective was to determine if MRCP affects management of patients who otherwise would undergo ERCP. A review was conducted of all MRCPs and ERCPs at our institution from 2008 to 2012 with suspected choledocholithiasis. Patients who underwent MRCP and ERCP were compared with those who underwent ERCP alone. Demographic data were collected and notation of whether a post-MRCP ERCP occurred was the primary variable. MRCP was performed in 107 patients for choledocholithiasis. Eighty-eight patients were negative for choledocholithiasis (82%) and 76 were discharged without ERCP (71%). Thirty-one patients received a diagnosis of choledocholithiasis and were referred for ERCP. Of the 19 patients with MRCP-diagnosed common bile duct stones, 95 per cent were confirmed by ERCP (odds ratio 18.0, P > 0.05; agreement 77%, sensitivity 0.76, specificity 0.86, positive predictive value 0.95, negative predictive value 0.50). Length of stay was similar for all groups. A total of 131 patients underwent ERCP without a preprocedural MRCP. Choledocholithiasis was found in 116 patients (92%), whereas 12 patients (9%) had no common bile duct stones and three had an alternate diagnosis. In conclusion, MRCP significantly affected the management of patients who would have undergone ERCP. MRCP did not increase length of stay and contributed to the 95 per cent positivity rate of subsequent ERCPs. These data illustrate the utility of MRCP in suspected choledocholithiasis patients at a low cost with regard to risk and time.

Combination of serum gamma-glutamyltransferase and alkaline phosphatase in predicting the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis

“…The examination methods of choledocholithiasis include abdominal B-ultrasound, computed tomography (commonly known as CT), MRCP, ERCP and endoscopic ultrasound (EUS)[12-14]. Abdominal B-ultrasound can accurately diagnose cholecystolithiasis and is the first choice for the examination of cholecystolithiasis.…”

Analysis of Endoscopic Retrograde Cholangiopancreatography in Rural Appalachia

“…1 Although MRCP is a less invasive procedure it offers diagnostic, not therapeutic, value in the assessment of biliary disease while presenting both a greater financial burden and difficulty in allocating limited health care resources. 2,3 Although ERCP has proven an invaluable technique in surgical and gastroenterological practice, its exact utility in the Appalachian population has yet to be precisely elucidated. Due to the low socioeconomic status of the patient population and physician preference the decision to perform ERCP has been guided by chemistries suggestive of biliary obstructive disease or based on clinical suspicion.…”

A retrospective analysis of magnetic resonance cholangiopancreatography investigating gallstones in a contemporary surgical setting

“…In patients with gallstone disease it is important to identify the risk of common bile duct (CBD) stones to proceed with appropriate surgical management. Magnetic Resonance Cholangiopancreatography (MRCP) is accurate and internationally its preoperative use has increased due to its availability and non‐invasive nature 1 . However, surgical departments within New Zealand are operating within a resource limited system that has severe limitations 2 .…”