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 25 May 2018

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Detecting bile duct stones in suspected biliary pancreatitis

Magnetic resonance cholangiopancreatography can be used to select patients with biliary pancreatitis who require endoscopic retrograde cholangiopancreatography, whilst intraductal ultrasound may be applied to pancreatitis management, reports the latest issue of the American Journal of Gastroenterology.

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Early endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy for stone extraction can benefit the prognosis in patients with severe biliary pancreatitis.

However, these are associated with complications.

The ability to identify choledocholithiasis by noninvasive means in biliary pancreatitis is limited.

Dr Chan Sup Shim and colleagues from Korea evaluated the ability of magnetic resonance cholangiopancreatography to detect choledocholithiasis in patients with acute biliary pancreatitis.

In addition, the research team investigated whether intraductal ultrasound could help manage these patients.

The sensitivity of ultrasound for identifying choledocholithiasis was 20 %
American Journal of Gastroenterology

The researchers prospectively studied 32 patients with suspected biliary pancreatitis.

The team performed magnetic resonance cholangiopancreatography immediately before endoscopic retrograde cholangiopancreatography using separate and blinded examiners within 24 hours of admission.

Wire-guided intraductal ultrasound was performed during endoscopic retrograde cholangiopancreatography within 72 hours of admission, regardless of the results of magnetic resonance cholangiopancreatography.

The investigators obtained the diagnostic yield of magnetic resonance cholangiopancreatography using endoscopic extraction of a stone as the reference standard.

The team then compared these results with transabdominal ultrasound, computed tomography, endoscopic retrograde cholangiopancreatography, and intraductal ultrasound.

The researchers reported that the sensitivity of ultrasound, computed tomography, magnetic resonance cholangiopancreatography for identifying choledocholithiasis was 20 %, 40 %, 80 %, respectively.

In addition, the team found that the sensitivity of endoscopic retrograde cholangiopancreatography, and intraductal ultrasound for identifying choledocholithiasis was 90 %, and 95 %, respectively.

The overall agreement between magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography was 91 % for choledocholithiasis.

The team observed that the sensitivity of magnetic resonance cholangiopancreatography for detecting choledocholithiasis decreased with dilated bile ducts of a diameter more than 10 mm, and was 73 % versus 89 %.

The research team found that the combination of endoscopic retrograde cholangiopancreatography and intraductal ultrasound improved accuracy in the diagnosis of choledocholithiasis.

Dr Sup Shim’s team concludes, “Magnetic resonance cholangiopancreatography can be used to select patients with biliary pancreatitis who require endoscopic retrograde cholangiopancreatography.”

“Intraductal ultrasound may be applied in the management of biliary pancreatitis if endoscopic retrograde cholangiopancreatography is performed.”

Am J Gastroenterol 2005: 100(5): 1051
26 April 2005

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