Comparison of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in the diagnosis of pancreatobiliary diseases: a prospective study.
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.
Fernández-Esparrach
Glòria
G
Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, CIBER HEPAD, University of Barcelona, Barcelona, Spain.
Ginès
Angels
A
Sánchez
Marcelo
M
Pagés
Mario
M
Pellisé
Maria
M
Fernández-Cruz
Laureano
L
López-Boado
Miguel Angel
MA
Quintó
Llorenç
L
Navarro
Salvador
S
Sendino
Oriol
O
Cárdenas
Andrés
A
Ayuso
Carmen
C
Bordas
Josep M
JM
Llach
Josep
J
Castells
Antoni
A
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