Bunyamin GURBULAK, Muhammed Zubeyr UCUNCU

Comparison of diagnostic efficacy of MRCP and ERCP in the management of choledocholithiasis

Aim: We compared the accuracy of MRCP and ERCP findings in the management of suspected common bile duct stones.Material and Methods: Between September and December 2017, 104 patients underwent MRCP and then ERCP to explain the etiology of cholestasis and elevated liver enzymes and / or the bilirubin levels. Laboratory values and MRCP were compared with ERCP findings for the accuracy and reliability of laboratory and radiological findings.Results: The one-hundred four patients underwent MRCP and then ERCP. Of these, 49 (47.1%) were males. The mean age of the patients was 60.7 ± 16.4 years. When compared MRCP and ERCP findings, the sensitivity of MRCP was 71%, specificity was 35%, negative predictive value (NPV) was 31% and positive predictive value(PPV) was 75%. The accuracy rate was calculated as 61%Conclusion: The diagnosis of choledocholithiasis, should have been done with primarily MRCP and EUS should be used in cases when MRCP is inadequate. ERCP should be used for only in therapeutic procedures.

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1. Everhart JE, Khare M, Hill M, et al. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999;117:632-9.
2. Russo MW, Wei JT, Thiny MT, et al. Digestive and liver diseases statistics 2004. Gastroenterolo-gy. 2004;126:1448-53.
3. Frossard JL, Hadengue A, Amouyal G, et al. Choledocholithiasis: a prospective study of spontane-ous common bile duct pancreatology stone migration. Gastrointest Endosc 2000;51:175-9.
4. Kedia S, Dhingra R, Garg PK. Recurrent acute pancreatitis: an approach to diagnosis and manage-ment. Trop Gastroenterol 2014;34:123-35.
5. Levy MJ, Geenen JE. Idiopathic acute recurrent pancreatitis. Am J Gastroenterol 2001;96:2540-55.
6. Anciaux ML, Pelletier G, Attali P, et al. Prospective study of clinical and biochemical features of symptomatic choledocholithiasis. Dig Dis Sci 1986;31:449-53.
7. Roston AD, Jacobson IM. Evaluation of the pattern of liver tests and yield of cholangiography in symptomatic choledocholithiasis: a prospective study. Gastrointest Endosc 1997;45:394-9.
8. Barbara L, Sama C, Morselli Labate AM, et al. A population based study on the prevalence of gall-stone disease: the Sirmione study. Hepatology 1987;7:913-7.
9. Acosta JM, Ledesma CL. Gallstone migration as a cause of acute pancreatitis. N Engl J Med 1974;290:484-7.
10. Yusuf TE, Bhutani MS. Role of endoscopic ultrasonography in diseases of the extrahepatic biliary system. J Gastroenterol Hepatol 2004;19:243-50.
11. Al-Jiffry BO, Elfateh A, Chundrigar T, et al. Non-invasive assessment of choledocholithiasis in patients with gallstones and abnormal liver func¬tion. World J Gastroenterol 2013;19:5877-82.
12. Rahman R, Ju J, Shamma’s J, et al. Correlation between MRCP and ERCP findings at a tertiary care hospital. W V Med J 2010;106:14-9.
13. Chang JH, Lee IS, Lim YS, et al. Role of magnetic resonance cholangiopancreatography for chole-docholithiasis: analysis of patients with negative MRCP. Scand J Gastroenterol 2012;7:217-24.
14. Sohns JM, Staab W, Dabir D, et al. Current role and future potential of magnetic resonance cholan-giopancreatography with an emphasis on incidental findings. Clin Imaging 2014;38:35-41.
15. Barish MA, Yucel EK, Ferrucci JT. Magnetic resonance cholangiopancreatogra¬phy. N Engl J Med 1999;341:258-64.
16. Makary MA, Duncan MD, Harmon JW, et al. The role of magnetic resonance cholangiography in the man¬agement of patients with gallstone pancreatitis. Ann surg 2005;241:119-24.
17. Gosset J, Devière J, Matos C. Magnetic resonance imaging of acute pancreatitis: the pancreatogram. JOP 2004;5:48-50.
18. De Waele E, Op de Beeck B, De Waele B, et al. Magnetic resonance cholangiopancreatography in the preoperative assessment of patients with biliary pancreatitis. Pancreatology 2007;7:347-51.
19. Canlas KR, Branch MS. Role of endoscopic retrograde cholangiopancreatography in acute pancrea-titis. World J Gastroenterol 2007;13:6314-20.
20. Al-Haddad M, Wallace MB. Diagnostic approach to patients with acute idio¬pathic and recurrent pancreatitis, what should be done? World J Gastro¬enteral 2008;14:1007-10.
21. Fulcher AS. MRCP and ERCP in the diagnosis of common bile duct stones. Gastrointest Endosc 2002;56(suppl 6): S178-82.
22. Cotton PB, Yaghoobi M. Adverse events. In: Cotton PB, Leung J, editors. ERCP: The fundamentals, 2nd ed. Chichester (UK): John Wiley & sons; 2014. p. 369-96.
23. Schofl R, Haefner M. Diagnostic cholangiopancreatography. Endoscopy 2003;35:145-55.
24. Behrns KE, Ashley SW, Hunter JG, et al. Early ERCP for galstone pancreatitis: for whom and when? J Gastrointest Surg 2008;12:629-33.
25. Vázquez-Sequeiros E, González-Panizo Tamargo F, Boixeda-Miquel D, et.al. Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocho¬lithiasis and absence of findings in magnetic resonance cholangiogra¬phy. Rev Esp Enferm Dig 2011;103:464-71.
26. Rana SS, Bhasin DK, Sharma V, et al. Role of en¬doscopic ultrasound in evaluation of unexplained common bile duct dilatation on magnetic resonance cholangiopancreatography. Ann Gas¬troenterol 2013;26:66-70.
27. Kondo S, Isayama H, Akahane M, et al. Detection of common bile duct stones: comparison be-tween endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholan¬giography. Eur J Radiol 2005;54:271-75.
28. Amouyal P, Palazzo L, Amoyal G, et al. Endosonography: promising method for diagnosis of extra-he¬patic cholestasis. The Lancet. 1989;334:1195-98.
29. Dill J, Hill S, Callis J, et al. Combined endoscopic ultrasound and stimulated biliary drain¬age in cholecystitis and microlithiasis-diagnoses and outcomes. Endoscopy 1995;27:424-27.
30. Dahan P, Andant C, Lévy P, et al. Prospective evaluation of endoscopic ultrasonography and micro-scopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with nor-mal conventional ultrasonography. Gut 1996;38:277-81.
31. Frossard JL, Sosa-Valencia L, Amouyal G, et al. Usefulness of endoscopic ultrasonography in pa-tients with “idiopathic” acute pancreatitis. Am J Med 2000;109:196-200.
32. Rana SS, Gonen C, Vilmann P. Endoscopic ultrasound and pancreas divisum. Journal of the Pan-creas 2012;13:252-57.
33. Rösch T, Lightdale CJ, Botet JF, et al. Localization of pancreatic endocrine tumors by endoscopic ultra¬sonography. N Engl J Med 1992;326:1721-26.
34. Verma D, Kapadia A, Eisen GM, et al. EUS vs MRCP for detection of choledocholithiasis. Gastroin-test Endosc 2006;64:248-54.
35. Aljebreen A, Azzam N, Eloubeidi MA. Prospective study of endoscopic ultrasound performance in suspected choledocholithiasis. J Gastroenterol Hepatol 2008;23:741-5.
36. Liu CL, Lo CM, Chan JK, et al. EUS for detection of occult cholelithiasis in patients with idiopathic pancreatitis. Gastrointest Endosc 2000;51:28-32.
37. Makmun D, Fauzi A, Shatri H. Sensitivity and Specificity of Magnetic Resonance Cholangiopancre-atography versus Endoscopic Ultrasonography against Endoscopic Retrograde Cholangiopancrea-tography in Diagnosing Choledocholithiasis: The Indonesian Experience. Clin Endosc 2017;50:486-90.
38. Benjaminov F, Stein A, Lichtman G, et al. Consecutive versus separate sessions of endoscopic ul-trasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) for symptomatic choledocholithiasis. Surg Endosc 2013;27:2117-21.
39. Meeralam Y, Al-Shammari K, Yaghoobi M. Diagnostic accuracy of EUS compared with MRCP in detecting choledocholithiasis: a meta-analysis of diagnostic test accuracy of head-to-head studies. Gastrointest Endosc 2017;86:986-93.
40. Alhayaf N, Lalor E, Bain V, et al. The clinical impact and cost implication of endoscopic ultrasound on use of endo¬scopic retrograde cholangiopancreatography in a Canadian university hospital. Can J Gastroenterol 2008;22:138-42.
41. Freitas ML, Bell RL, Duffy AJ. Choledocholithiasis: evolving standards for diagnosis and manage-ment. World J Gastroenterol 2006;12:3162-7.