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*************   There are many advantages of MRCP compared with previous imaging techniques. It does not require the use of contrast so avoiding the possibility of a reaction. In fact, safety is comparable to ultrasound providing the few contraindications are observed and since no radiation is used. No special patient preparation is required and the procedure is very rapid to perform.

 

When compared to ERCP or PTC the accuracy is very similar. MRCP has a sensitivity and specificity of 91% and 98% respectively for choledocholithiasis (1,2,3). Its accuracy for benign and malignant obstruction is 90%. Furthermore, it does not carry the 5-30% failure rate associated with ERCP(4). It is also spares the morbidity (1-7%) and mortality (0.2 1%) of ERCP (4,5) and is twice as cost effective(5).

 

The disadvantage is that it is solely a diagnostic test. For this reason it should not be used in choledocholithiasis when there is a high likelihood of a CBD stone. In this situation ERCP would be indicated since endobiliary therapy can also be carried out. MRCP is not the initial investigation of choice in cholecystitis as ultrasound is just as accurate and much mokre cost effective.

Source MRCP info From Royal College of Surgeons Edinburg website.

 

Time for Change No doubt, if ERCP was a completely (or at least reasonably) harmless procedure, there would be no room for this editorial as well as dozens of clinical trials on the prevention of post-ERCP complications. However, ERCP is one of the most challenging endoscopic procedures with a reported rate of procedure-related complications of approximately 5-10%. Moreover, in some cases it may even lead to mortality. It is generally agreed that the main aim of ERCP in patients with acute biliary pancreatitis is to detect main bile duct stones; however, in fact, ERCP is capable of doing this in only 39-46% of cases. This means that at least one in two patients undergoes a futile endoscopic intervention. Furthermore, given that recent randomized and non-randomized studies demonstrated a 71-88% rate of spontaneous disobstruction within 48 h after the onset of acute biliary pancreatitis (and subsequent uneventful course of acute pancreatitis), only a small subgroup of patients might, in fact, have a theoretical justification for undergoing ERCP. In addition, evolutionary pressure from competing technologies (endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) has greatly challenged the need for diagnostic ERCP. This is evidenced by the results of a recent study from the U.S.A. which investigated trends in the utilization of ERCP since 1988. In the cohort of more than 400,000 patients, a steep rise was found in the usage of ERCP until 1996 whereas its utilization steadily fell afterwards (coincidentally or not, the first randomized controlled trial which underscored the lack of clinical benefits from ERCP was published at the same time- in January 1997.

 

The Ops position was that advice of spincterotomy ERCP was given as that was the only procedure which offered best diagnosis and treatment at the same go as per standard practice followed everywhere and this is laid down in medical texts for the purpose of management of the case of such kind of patient, like Magnetic Resonance Imaging There is limited information on magnetic resonance imaging (MRI) or magnetic resonance cholangiopancreatography (MRCP) in patients with chronic pancreatitis. A number of small studies suggest that MRCP provides an acceptable assessment of pancreatic ductal morphology in most patients.

MCRP results agree with ERCP results in 70% to 80% of cases, with the higher rates of agreement seen in studies using the most advanced image analysis techniques. Agreement between MRCP and ERCP is worse in areas where the pancreatic duct is small (tail of pancreas and side branches).

Advancements in MR image analysis will continue to improve the image quality of MRCP, which in the future could approach ERCP in accuracy. For the moment, however, ERCP has superior spatial resolution. Like ERCP, however, MRCP will be inaccurate in patients without significant ductal abnormalities. Although MRI is widely available, not all centers have the capacity to perform high-quality MRCP.