title: MRCP in patient care: a prospective survey of gastroenterologists.
abstract: OBJECTIVE
  MRCP is increasingly used to evaluate pancreaticobiliary disease, yet its effect on patient care is unknown. The purpose of this study was to measure the effect of MRCP on referring physicians' initial diagnoses, the physicians' confidence in their diagnoses, and the influence of MRCP results on clinical management.
  
  
  METHODS
  We prospectively surveyed gastroenterologists who referred patients for nonurgent MRCP for pancreaticobiliary evaluation. Before MRCP, gastroenterologists reported the working diagnosis, confidence level (high, moderate, low), and next step in clinical management if MRCP was unavailable. MRCP was performed with standard protocols, including secretin enhancement. After reviewing MRCP findings and without referring to their previous assessment, gastroenterologists reported a revised diagnosis, confidence level, and next step in clinical management. They then compared pre- and post-MRCP management plans and rated the influence of MRCP on changing management from 1 (none) to 5 (major). Diagnostic confidence and frequency of common diagnoses and recommendation for an invasive next-step procedure (e.g., ERCP) or endoscopic ultrasound were compared between pre- and post-MRCP assessments.
  
  
  RESULTS
  Survey data were analyzed on 171 patients (123 women, 48 men; mean age, 50 [SD, 17] years; range, 19-88 years) undergoing MRCP for unexplained abdominal pain (42.9%), suspected pancreaticobiliary neoplasm (20%), recent acute (17.1%) or suspected chronic (14.9%) pancreatitis, and other indications (5.1%). Recommendations of ERCP and endoscopic ultrasound decreased after MRCP (from 49.1% to 35.1%, p=0.03, and from 26.9% to 13.5%, p≤0.01). After MRCP, high confidence in diagnosis increased (from 72/171 to 100/171, p<0.01), as did recommendations for noninvasive therapy (from 18/171 to 56/171, p<0.01). A major or substantial change in clinical management was made in the care of 67 of 171 patients (39.2%).
  
  
  CONCLUSIONS
  Use of MRCP significantly changes gastroenterologists' treatment of patients with suspected pancreaticobiliary disease by increasing diagnostic confidence and reducing the frequency of invasive follow-up procedures.
authors: Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Rm 0615, Indianapolis, IN 46202, USA. makisik@iupui.edu
authors: M Fatih
authors: MF
authors: Akisik
authors: S Gregory
authors: SG
authors: Jennings
authors: Alex M
authors: AM
authors: Aisen
authors: Stuart
authors: S
authors: Sherman
authors: Gregory A
authors: GA
authors: Cote
authors: Kumaresan
authors: K
authors: Sandrasegaran
authors: Temel
authors: T
authors: Tirkes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance / Q000706:statistics & numerical data*; D003287:Contrast Media; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation
chemical_list: D003287:Contrast Media