Diagnostic role of secretin-enhanced MRCP in patients with unsuccessful ERCP.
OBJECTIVE
To evaluate the value of MR cholangiopancreatography (MRCP) in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessfully performed by experts in a tertiary center.


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 acute pancreatitis (n = 2), or suspected pancreatic cancer (n = 1). The reasons for the ERCP failure were the postsurgical anatomy (n = 7), duodenal stenosis (n = 3), duodenal diverticulum (n = 2), and technical failure (n = 10). MRCP images were evaluated before and 5 and 10 min after i.v. administration of 0.5 IU/kg secretin.


RESULTS
The MRCP images were diagnosed in all 21 patients. Five patients gave normal MR findings and required no further intervention. MRCP revealed abnormalities (primary sclerosing cholangitis, chronic pancreatitis, cholangitis, cholecystolithiasis or common bile duct dilation) in 10 patients, who were followed up clinically. Four patients subsequently underwent laparotomy (hepaticojejunostomy in consequence of common bile duct stenosis caused by unresectable pancreatic cancer; hepaticotomy+Kehr drainage because of insufficient biliary-enteric anastomosis; choledochojejunostomy, gastrojejunostomy and cysto-Wirsungo gastrostomy because of chronic pancreatitis, or choledochojejunostomy because of common bile duct stenosis caused by chronic pancreatitis). Three patients participated in therapeutic percutaneous transhepatic drainage. The indications were choledocholithiasis with choledochojejunostomy, insufficient biliary-enteric anastomosis, or cholangiocarcinoma.


CONCLUSIONS
MRCP can assist the diagnosis and management of patients in whom ERCP is not possible.
Czakó
László
L
First Department of Medicine, University of Szeged, Szeged, Hungary. czal@in1st.szote.u-szeged.hu
Takács
Tamás
T
Morvay
Zita
Z
Csernay
László
L
Lonovics
János
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000175:diagnosis* / 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; D010195:Pancreatitis / Q000175:diagnosis; D011446:Prospective Studies; D012633:Secretin; D012680:Sensitivity and Specificity
D012633:Secretin