Diagnosis of exocrine diseases of the pancreas: is there still a role for endoscopic retrograde cholangiopancreatography (ERCP)?
In the diagnosis of exocrine diseases of the pancreas, three major questions should be addressed: when only MR cholangiopancreatography should be applied; when endoscopic retrograde cholangiopancreatography should be applied directly; when a combined approach should be applied. In pancreatic disease MRI has many indications because ultrasonography, the procedure of choice, is rarely able to resolve the diagnostic problem, with a clearcut indication for therapeutic endoscopic retrograde cholangiopancreatography. One of the rare cases where MRI could be omitted is represented by pancreatic cancer with biliary obstruction in non operable patients in whom a pancreatic mass was already visualized on ultrasonography. In all other diseases of the pancreas, the combination of MRI/MRCP with secretin stimulation and ERCP usually favors the first procedure, preventing a number of diagnostic ERCP.
Mutignani
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M
Unità Operativa di Endoscopia Digestiva Chirurgica, Dipartimento di Scienze Chirurgiche, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.
Riccioni
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Costamagna
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D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D008279:Magnetic Resonance Imaging; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010182:Pancreatic Diseases / Q000175:diagnosis*