Diagnostic Role of Secretin-enhanced MRCP in Patients with Unsuccessful ERCP

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2004 Sep 21

PMID 15378788

Citations 5

Authors

Laszlo Czako

Tamas Takacs

Zita Morvay

Laszlo Csernay

Janos Lonovics

Affiliations

Soon will be listed here.

Abstract

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; choledochojejunostomy, 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.

Citing Articles

Endoscopic characteristics and usefulness of endoscopic dilatation of anastomotic stricture following pancreaticojejunostomy: case series and a review of the literature.

Kida A, Shirota Y, Houdo Y, Wakabayashi T Therap Adv Gastroenterol. 2016; 9(6):913-919.

PMID: 27803744 PMC: 5076772. DOI: 10.1177/1756283X16663877.

Management of afferent loop obstruction: Reoperation or endoscopic and percutaneous interventions?.

Blouhos K, Boulas K, Tsalis K, Hatzigeorgiadis A World J Gastrointest Surg. 2015; 7(9):190-5.

PMID: 26425267 PMC: 4582236. DOI: 10.4240/wjgs.v7.i9.190.

The physiological roles of secretin and its receptor.

Afroze S, Meng F, Jensen K, McDaniel K, Rahal K, Onori P Ann Transl Med. 2014; 1(3):29.

PMID: 25332973 PMC: 4200670. DOI: 10.3978/j.issn.2305-5839.2012.12.01.

Role of secretin-enhanced magnetic resonance cholangiopancreatography in the evaluation of patients following pancreatojejunostomy.

Anis M, Mortele K J Clin Imaging Sci. 2013; 3:7.

PMID: 23607076 PMC: 3625885. DOI: 10.4103/2156-7514.107909.

Prospective comparison of secretin-stimulated magnetic resonance cholangiopancreatography with manometry in the diagnosis of sphincter of Oddi dysfunction types II and III.

Pereira S, Gillams A, Sgouros S, Webster G, Hatfield A Gut. 2006; 56(6):809-13.

PMID: 17005767 PMC: 1954855. DOI: 10.1136/gut.2006.099267.

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