title: Diagnostic yield of secretin-enhanced magnetic resonance cholangiopancreatography in the investigation of patients with acalculous biliary pain.
abstract: BACKGROUND
  Secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) facilitates better visualization of the pancreaticobiliary ductal system but its role in patients with acalculous biliary pain (ABP) is yet to be established. The aim of this study was to assess the diagnostic yield and the role of S-MRCP in the investigation of ABP patients.
  
  
  METHODS
  This is a retrospective analysis of patients who had S-MRCP to investigate ABP over a 5-year period from June 2008 to May 2013. The findings and diagnosis as reported in the S-MRCP were compared with the findings on MRCP. The primary endpoint was the diagnostic yield of S-MRCP in ABP patients.
  
  
  RESULTS
  A total of 117 patients with ABP [28 (24%) male] had S-MRCP during the study period. The most common abnormality identified was obstruction at the level of ampulla or in the proximal pancreatic duct. S-MRCP was able to identify significant pathological findings in 8 of 34 (22%) patients in whom MRCP did not detect any abnormality. Endoscopic ultrasound (EUS) was performed in 67% of patients. S-MRCP identified abnormalities in 21 of 41 (54%) patients who had a normal EUS.
  
  
  CONCLUSIONS
  We conclude that the diagnostic yield of S-MRCP for recognizing anatomical variants of the pancreatic ductal system, in particular ampullary or proximal pancreatic duct stricture, is better than MRCP and EUS. These findings reflect the dynamic nature of S-MRCP and its complementary role alongside MRCP, EUS and endoscopic retrograde cholangiopancreatography in ABP patients.
authors.affiliation: Department of Surgery (Shridhar Dronamraju), Newcastle upon Tyne, UK.
authors.forename: Shridhar
authors.initials: S
authors.lastname: Dronamraju
authors.affiliation: Department of GI Radiology (John Scott), Newcastle upon Tyne, UK.
authors.forename: John
authors.initials: J
authors.lastname: Scott
authors.affiliation: Department of Gastroenterology (Kofi Oppong, Manu Nayar), Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Kofi
authors.initials: K
authors.lastname: Oppong
authors.affiliation: Department of Gastroenterology (Kofi Oppong, Manu Nayar), Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Manu
authors.initials: M
authors.lastname: Nayar
keywords: MRCP; abdominal pain; endosonography; secretin; visceral pain