title: Postprocedural interpretation of endoscopic retrograde cholangiopancreatography by radiology.
abstract: BACKGROUND
  With the increase in the use of endoscopic retrograde cholangiopancreatography (ERCP) (necessitating real-time interpretation), it is unknown whether post-ERCP radiologist reporting is still necessary or helpful.
  
  
  OBJECTIVE
  To determine the rate of discrepancy of results, and the rate of clinically relevant misses and additions, by the radiology report in a blinded setting.
  
  
  METHODS
  A retrospective analysis of the procedure and blinded postprocedure radiology reports of 100 consecutive ERCP cases was performed. A list of clinically relevant pathology and subgroups was made a priori. Discrepancies are described as proportions, with 95% CIs. The radiology yield regarding pathology that was clearly demonstrated at ERCP (bile leaks and stones removed) was calculated. Clinical follow-up was used to clarify additional abnormalities reported by radiology.
  
  
  RESULTS
  Clinically relevant discrepancies in report pairs occurred in 29.0% of cases (95% CI 20% to 39%), or 40.0% if discrepancies regarding bile duct dilation are considered (95% CI 30% to 50%). In 15 of 30 cases (50.0% [95% CI 31% to 69%]) in which bile duct stones were removed, the radiologist did not report a stone. The radiologist did not report five of eight bile leaks (62.5% [95% CI 24% to 91%]). In seven cases (7.0% [95% CI 2.9% to 13.9%]), an additional abnormality was noted by radiology, including a biliary stricture, bile duct and pancreatic duct stones, as well as sclerosing cholangitis. However, during a mean follow-up period of 5.6 months, it appeared that these radiology interpretations were likely incorrect. Discrepancy rates did not vary among the ERCP attendings or by radiology volume.
  
  
  CONCLUSIONS
  Discrepancies between endoscopists' and radiologists' ERCP reports are common. Blinded radiology interpretation frequently misses important pathology, and falsely positive additional diagnoses may be made.
authors.affiliation: Department of Medicine (Division of Gastroenterology), University of Western Ontario, London, Canada.
authors.forename: Nitin
authors.initials: N
authors.lastname: Khanna
authors.forename: Gary
authors.initials: G
authors.lastname: May
authors.forename: Sydney
authors.initials: S
authors.lastname: Bass
authors.forename: Marty
authors.initials: M
authors.lastname: Cole
authors.forename: Joseph
authors.initials: J
authors.lastname: Romagnuolo
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011871:Radiology / Q000592:standards*; D012189:Retrospective Studies; D016037:Single-Blind Method