title: Controversial issues in biliary pancreatitis: when should we perform MRCP and ERCP?
abstract: OBJECTIVE
  The majority of bile duct stones (BDS) that cause acute biliary pancreatitis (ABP) pass spontaneously into the duodenum. If not passed, they worsen the prognosis or cause recurrence. Therefore, they must be treated. The purpose of this study was to assess the number and timing of spontaneous passage of BDS using magnetic resonance cholangiopancreatography (MRCP) and to determine the effect of this approach on endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  METHODS
  Sixty patients diagnosed with ABP were evaluated prospectively. MRCP was performed between the 1st and 4th days of an acute attack in all the patients. A control MRCP was performed after 7 days in patients with MRCP-identified choledocholithiasis. Patients in whom BDS were visible on imaging or who showed no decrease in bilirubin or cholestasis enzymes underwent ERCP.
  
  
  RESULTS
  MRCP revealed choledocholithiasis in 20 (33%) of the 60 patients. In the control MRCP imaging, choledocholithiasis was detected in 16 of 20 (80% of those who had stone initially) patients. ERCP was performed in these patients and in 2 patients who did not have BDS on the control MRCP but whose bilirubin values and cholestatic enzyme levels had not decreased. ERCP verified choledocholithiasis in 16 of the 18 patients. The positive predictive value of MRCP was 93.7% (15/16).
  
  
  CONCLUSIONS
  MRCP performed in the second week in ABP patients with a nonworsening prognosis and a suspicion of choledocholithiasis will give more specific results. This will avoid unnecessary ERCP and the potential morbidity and mortality that can develop with this invasive procedure.
authors.affiliation: Department of General Surgery, Yalova State Hospital, Yalova, Turkey. Electronic address: drcavdarf@hotmail.com.
authors.forename: Faruk
authors.initials: F
authors.lastname: Cavdar
authors.affiliation: Department of General Surgery, Balıkesir University Faculty of Medicine, Balıkesir, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Yildar
authors.affiliation: Department of General Surgery, Gaziosmanpaşa Private Hospital, Istanbul, Turkey.
authors.forename: Gürkan
authors.initials: G
authors.lastname: Tellioğlu
authors.affiliation: Department of General Surgery, Haydarpaşa Training and Research Hospital, Istanbul, Turkey.
authors.forename: Melih
authors.initials: M
authors.lastname: Kara
authors.affiliation: Department of General Surgery, Haydarpaşa Training and Research Hospital, Istanbul, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Tilki
authors.affiliation: Department of General Surgery, Haydarpaşa Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mesut İzzet
authors.initials: Mİ
authors.lastname: Titiz
mesh_terms: D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D042883:Choledocholithiasis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D019564:Unnecessary Procedures
keywords: Acute; Choledocholithiasis; ERCP; EUS; MRCP; Pancreatitis