title: Is MRCP equivalent to ERCP for diagnosing biliary obstruction in orthotopic liver transplant recipients? A meta-analysis.
abstract: BACKGROUND
  Biliary complications are the second leading cause of morbidity and mortality in orthotopic liver transplant (OLT) recipients. Endoscopic retrograde cholangiography (ERC) is considered the diagnostic criterion standard for post-orthotopic liver transplantation biliary obstruction, but incurs significant risks.
  
  
  OBJECTIVE
  To determine the diagnostic accuracy of MRCP for biliary obstruction in OLT patients.
  
  
  METHODS
  A systematic literature search identified studies primarily examining the utility of MRCP in detecting post-orthotopic liver transplantation biliary obstruction. A meta-analysis was then performed according to the Quality of Reporting Meta-Analyses statement.
  
  
  METHODS
  Meta-analysis of 9 studies originally performed at major transplantation centers.
  
  
  METHODS
  A total of 382 OLT patients with clinical suspicion of biliary obstruction.
  
  
  METHODS
  MRCP and ERCP or clinical follow-up.
  
  
  METHODS
  Sensitivity and specificity of MRCP for diagnosis of biliary obstruction.
  
  
  RESULTS
  The composite sensitivity and specificity were 0.96 (95% CI, 0.92-0.98) and 0.94 (95% CI, 0.90-0.97), respectively. The positive and negative likelihood ratios were 17 (95% CI, 9.4-29.6) and 0.04 (95% CI, 0.02-0.08), respectively.
  
  
  CONCLUSIONS
  All but 1 included study had significant design flaws that may have falsely increased the reported diagnostic accuracy.
  
  
  CONCLUSIONS
  The high sensitivity and specificity demonstrated in this meta-analysis suggest that MRCP is a promising test for diagnosing biliary obstruction in patients who have undergone liver transplantation. However, given the significant design flaws in most of the component studies, additional high-quality data are necessary before unequivocally recommending MRCP in this setting.
authors.affiliation: Department of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan 48109-5362, USA. jjorg@umich.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Jorgensen
authors.forename: Akbar K
authors.initials: AK
authors.lastname: Waljee
authors.forename: Michael L
authors.initials: ML
authors.lastname: Volk
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sonnenday
authors.forename: Grace H
authors.initials: GH
authors.lastname: Elta
authors.forename: Mahmoud M
authors.initials: MM
authors.lastname: Al-Hawary
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
authors.forename: Jason R
authors.initials: JR
authors.lastname: Taylor
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D012680:Sensitivity and Specificity; D016042:Transplantation, Heterotopic / Q000009:adverse effects