Clinical Research
Copyright ©The Author(s) 2004. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 15, 2004; 10(20): 3034-3038
Published online Oct 15, 2004. doi: 10.3748/wjg.v10.i20.3034
Diagnostic role of secretin-enhanced MRCP in patients with unsuccessful ERCP
László Czakó, Tamás Takács, Zita Morvay, László Csernay, János Lonovics
László Czakó, Tamás Takács, János Lonovics, First Department of Medicine, University of Szeged, Szeged, Hungary
Zita Morvay, László Csernay, International Medical Center, Szeged, Hungary
Author contributions: All authors contributed equally to the work.
Supported by the ETT 5K503 and the Hungarian Academy of Sciences, BÖ 5/2003
Correspondence to: Dr. László Czakó, First Department of Medicine, University of Szeged, Szeged, PO Box 469, H-6701, Hungary.
Telephone: +36-62-545201 Fax: +36-62-545185
Received: February 20, 2004
Revised: March 2, 2004
Accepted: April 6, 2004
Published online: October 15, 2004

AIM: To evaluate the value of MR cholangiopancreatography (MRCP) in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessfully performed by experts in a tertiary center.

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 acute pancreatitis (n = 2), or suspected pancreatic cancer (n = 1). The reasons for the ERCP failure were the postsurgical anatomy (n = 7), duodenal stenosis (n = 3), duodenal diverticulum (n = 2), and technical failure (n = 10). MRCP images were evaluated before and 5 and 10 min after i.v. administration of 0.5 IU/kg secretin.

RESULTS: The MRCP images were diagnosed in all 21 patients. Five patients gave normal MR findings and required no further intervention. MRCP revealed abnormalities (primary sclerosing cholangitis, chronic pancreatitis, cholangitis, cholecystolithiasis or common bile duct dilation) in 10 patients, who were followed up clinically. Four patients subsequently underwent laparotomy (hepaticojejunostomy in consequence of common bile duct stenosis caused by unresectable pancreatic cancer; hepaticotomy + Kehr drainage because of insufficient biliary-enteric anastomosis; choledochoj-ejunostomy, gastrojejunostomy and cysto-Wirsungo gastrostomy because of chronic pancreatitis, or choledochojejunostomy because of common bile duct stenosis caused by chronic pancreatitis). Three patients participated in therapeutic percutaneous transhepatic drainage. The indications were choledocholithiasis with choledochojejunostomy, insufficient biliary-enteric anastomosis, or cholangiocarcinoma.

CONCLUSION: MRCP can assist the diagnosis and management of patients in whom ERCP is not possible.

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