[Diagnostic value of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP)].

Abstract

BACKGROUND AND AIMS:

To evaluate the value of S-MRCP in patients in whom ERCP performed by experts in a tertiary center were unsuccessful.

PATIENTS AND METHODS:

From January 2000 to June 2003, 22 patients fulfilled the inclusion criteria. The indications for ERCP were obstructive jaundice (n = 9), abnormal liver enzymes (n = 8), suspected chronic pancreatitis (n = 2), recurrent pancreatitis (n = 2) or suspected pancreatic cancer (n = 1). The reasons for the ERCP failure were postsurgical anatomy (n = 7), duodenum stenosis (n = 3), duodenal diverticulum (n = 2), or technical failure (n = 10). MRCP images were evaluated before and 5 and 10 min after the i.v. administration of 0.5 IU/kg secretin.

RESULTS:

The MRCP images were diagnostic in all but 1 patient. Five patients gave normal MR fadings and required no further intervention. S-MRCP detected abnormalities (primary sclerosing cholangitis, chronic pancreatitis, cholangitis, cholecystolithiasis or common bile duct dilatation) in 10 patients, who were followed up clinically. Four patients subsequently underwent laparotomy (hepatico-jejunostomy owing to common bile duct stenosis caused by unresectable pancreatic cancer; hepaticotomy + Kehr drainage because of narrow biliary-enteric anastomosis; choledocho-jejunostomy, gastro-jejunostomy and Wirsungo-gastrostomy in consequence of chronic pancreatitis or choledocho-jejunostomy because of common bile duct stenosis caused by chronic pancreatitis). Three patients participated in therapeutic percutaneous transhepatic drainage; the indications were choledocholithiasis in one patient choledocho-jejunostomy anastomosis, narrow biliary-enteric anastomosis, or cholangiocarcinoma.

CONCLUSION:

S-MRCP is the method of choice in cases where ERCP is not possible.

• Authors: László Czakó, Tamás Takács, Zita Morvay, László Csernay, János Lonovics
• Journal: Orvosi hetilap (Orv Hetil) Vol. 145 Issue 10 Pg. 529-34 (Mar 07 2004) ISSN: 0030-6002 [Print] Hungary
• Vernacular Title: A szekretinnel érzékenyített mágneses rezonanciás cholangiopancreatographia (S-MRCP) diagnosztikus értéke sikertelen endoszkópos retrográd cholangiopancreatographia (ERCP) esetén.
• PMID: 15085592 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Secretin

Topics

• Adult
• Aged
• Biliary Tract Diseases (diagnosis, diagnostic imaging, surgery)
• Cholangiography (methods)
• Cholangiopancreatography, Endoscopic Retrograde
• Diagnosis, Differential
• Female
• Humans
• Jaundice, Obstructive (diagnosis)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Pancreatic Diseases (diagnosis, diagnostic imaging, surgery)
• Pancreatic Neoplasms (diagnosis)
• Pancreatitis (diagnosis)
• Predictive Value of Tests
• Secretin