title: Comparison of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in the diagnosis of pancreatobiliary diseases: a prospective study.
abstract: OBJECTIVE
  To compare the diagnostic value of endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in: (a) patients with a dilated biliary tree unexplained by ultrasonography (US) (group 1), and (b) the diagnosis of choledocholithiasis in patients with nondilated biliary tree (group 2).
  
  
  METHODS
  Patients were prospectively evaluated with EUS and MRCP. The gold standard used was surgery or EUS-FNA and ERCP, intraoperative cholangiography, or follow-up when EUS and/or MRCP disclosed or precluded malignancy, respectively. Likelihood ratios (LR) and pretest and post-test probabilities for the diagnosis of malignancy and choledocholithiasis were calculated.
  
  
  RESULTS
  A total of 159 patients met one of the inclusion criteria but 24 of them were excluded for different reasons. Thus, 135 patients constitute the study population. The most frequent diagnosis was choledocholithiasis (49% in group 1 and 42% in group 2, P= 0.380) and malignancy was more frequent in group 1 (35%vs 7%, respectively, P < 0.001). When EUS and MRCP diagnosed malignancy, its prevalence in our series (35%) increased up to 98% and 96%, respectively, whereas it decreased to 0% and 2.6% when EUS and MRCP precluded this diagnosis. In patients in group 2, when EUS and MRCP made a positive diagnosis of choledocholithiasis, its prevalence (42%) increased up to 78% and 92%, respectively, whereas it decreased to 6% and 9% when any pathologic finding was ruled out.
  
  
  CONCLUSIONS
  EUS and MRCP are extremely useful in diagnosing or excluding malignancy and choledocholithiasis in patients with dilated and nondilated biliary tree. Therefore, they are critical in the approach to the management of these patients.
authors.affiliation: Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, CIBER HEPAD, University of Barcelona, Barcelona, Spain.
authors.forename: Glòria
authors.initials: G
authors.lastname: Fernández-Esparrach
authors.forename: Angels
authors.initials: A
authors.lastname: Ginès
authors.forename: Marcelo
authors.initials: M
authors.lastname: Sánchez
authors.forename: Mario
authors.initials: M
authors.lastname: Pagés
authors.forename: Maria
authors.initials: M
authors.lastname: Pellisé
authors.forename: Laureano
authors.initials: L
authors.lastname: Fernández-Cruz
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: López-Boado
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.forename: Salvador
authors.initials: S
authors.lastname: Navarro
authors.forename: Oriol
authors.initials: O
authors.lastname: Sendino
authors.forename: Andrés
authors.initials: A
authors.lastname: Cárdenas
authors.forename: Carmen
authors.initials: C
authors.lastname: Ayuso
authors.forename: Josep M
authors.initials: JM
authors.lastname: Bordas
authors.forename: Josep
authors.initials: J
authors.lastname: Llach
authors.forename: Antoni
authors.initials: A
authors.lastname: Castells
mesh_terms: D000368:Aged; D049448:Cholangiopancreatography, Magnetic Resonance; D042883:Choledocholithiasis / Q000175:diagnosis*; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies