The preferred initial investigation with either magnetic resonance (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected biliary obstruction remains controversial in many clinical settings.
Dr Barkun and colleagues assessed the effectiveness of an initial MRCP vs. ERCP in the work-up of patients at moderate likelihood of a suspected biliary obstruction.
Patients with an unconfirmed benign biliary obstruction, based on laboratory and ultrasound findings, were randomized to an ERCP-first or MRCP-first strategy, stratified by level of obstruction.
|50% in the MRCP-first group ended up avoiding an ERCP in follow-up|
|Alimentary Pharmacology & Therapeutics|
The research team's primary outcome was the occurrence of a disease or procedure-related bilio-pancreatic adverse events within the next 12 months.
Secondary outcomes were the number of subsequent bilio-pancreatic procedures, duration of hospitalisation, days away from activities of daily living, quality of life (SF-36) and mortality.
The researchers randomized 126 patients to ERCP-first, and 131 to MRCP-first.
In follow-up, 14% of ERCP-first, and 19% MRCP-first patients experienced a procedure- or disease-related complication.
A cause of biliary obstruction was found in 40% vs. 50% of patients.
The research team found that 50% of patients in the MRCP-first group ended up avoiding an ERCP in follow-up.
The researchers noted that ERCP-first and MRCP-first patients were away from usual activities for 3 days, and 2 days, respectively.
Dr Barkun's team concludes, "A strategy of MRCP-first decreased the need for subsequent MRCPs, but not complications."
"Further study is required to define factors influencing the eventual use of MRCP vs. ERCP in appropriately selected patients."