[Diagnostic value of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP)].
OBJECTIVE
To evaluate the value of S-MRCP in patients in whom ERCP performed by experts in a tertiary center were unsuccessful.


METHODS
From January 2000 to June 2003, 22 patients fulfilled the inclusion criteria. The indications for ERCP were obstructive jaundice (n = 9), abnormal liver enzymes (n = 8), suspected chronic pancreatitis (n = 2), recurrent pancreatitis (n = 2) or suspected pancreatic cancer (n = 1). The reasons for the ERCP failure were postsurgical anatomy (n = 7), duodenum stenosis (n = 3), duodenal diverticulum (n = 2), or technical failure (n = 10). MRCP images were evaluated before and 5 and 10 min after the i.v. administration of 0.5 IU/kg secretin.


RESULTS
The MRCP images were diagnostic in all but 1 patient. Five patients gave normal MR fadings and required no further intervention. S-MRCP detected abnormalities (primary sclerosing cholangitis, chronic pancreatitis, cholangitis, cholecystolithiasis or common bile duct dilatation) in 10 patients, who were followed up clinically. Four patients subsequently underwent laparotomy (hepatico-jejunostomy owing to common bile duct stenosis caused by unresectable pancreatic cancer; hepaticotomy + Kehr drainage because of narrow biliary-enteric anastomosis; choledocho-jejunostomy, gastro-jejunostomy and Wirsungo-gastrostomy in consequence of chronic pancreatitis or choledocho-jejunostomy because of common bile duct stenosis caused by chronic pancreatitis). Three patients participated in therapeutic percutaneous transhepatic drainage; the indications were choledocholithiasis in one patient choledocho-jejunostomy anastomosis, narrow biliary-enteric anastomosis, or cholangiocarcinoma.


CONCLUSIONS
S-MRCP is the method of choice in cases where ERCP is not possible.
Czakó
László
L
Szegedi Tudományegyetem, Szent-Györgyi Albert Orvos- és Gyógyszerésztudományi Centrum, Altalános Orvostudományi Kar, I. Belgyógyászati Klinika, Szeged. czal@in1st.szote.u-szeged.hu
Takács
Tamás
T
Morvay
Zita
Z
Csernay
László
L
Lonovics
János
J
D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D002758:Cholangiography / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D010195:Pancreatitis / Q000175:diagnosis; D011237:Predictive Value of Tests; D012633:Secretin
D012633:Secretin