title: The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US.
abstract: OBJECTIVE
  Early ERCP and endoscopic sphincterotomy for stone extraction can benefit the prognosis in patients with severe biliary pancreatitis, but are associated with complications. The ability to identify choledocholithiasis by noninvasive means in biliary pancreatitis is limited. The aim of this study was evaluation of the ability of MRCP to detect choledocholithiasis in patients with acute biliary pancreatitis. In addition, we investigated whether intraductal US (IDUS) could help manage these patients.
  
  
  METHODS
  Thirty-two patients with suspected biliary pancreatitis were studied prospectively. MRCP was performed immediately before ERCP by separate blinded examiners within 24 h of admission. Wire-guided IDUS was performed during ERCP within 72 h of admission, regardless of the results of MRCP. Using endoscopic extraction of a stone as the reference standard, the diagnostic yield of MRCP was compared with transabdominal US, CT, ERCP, and IDUS.
  
  
  RESULTS
  The sensitivity of US, CT, MRCP, ERCP, and IDUS for identifying choledocholithiasis was 20.0%, 40.0%, 80.0%, 90.0%, and 95.0%, respectively. The overall agreement between MRCP and ERCP was 90.6% for choledocholithiasis (kappa= 0.808, p < 0.01). The sensitivity of MRCP for detecting choledocholithiasis decreased with dilated bile ducts (bile duct diameter > 10 mm, 72.7% vs 88.9%). The combination of ERCP and IDUS improved accuracy in the diagnosis of choledocholithiasis.
  
  
  CONCLUSIONS
  MRCP can be used to select patients with biliary pancreatitis who require ERCP. IDUS may be applied in the management of biliary pancreatitis if ERCP is performed.
authors.affiliation: Digestive Disease Center, Institute for Digestive Research, Soon Chun Hyang University School of Medicine, Seoul, Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Cha
authors.forename: Young Koog
authors.initials: YK
authors.lastname: Cheon
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Ahn
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Kim
authors.forename: Yun Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Lee
authors.forename: Moon Sung
authors.initials: MS
authors.lastname: Lee
authors.forename: Hae Kyung
authors.initials: HK
authors.lastname: Lee
authors.forename: Chan Sup
authors.initials: CS
authors.lastname: Shim
authors.forename: Boo Sung
authors.initials: BS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000175:diagnosis* / Q000628:therapy; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D016717:Sphincterotomy, Endoscopic; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional