Value of magnetic resonance cholangiopancreatography prior to endoscopic retrograde cholangiopancreatography in ultrasonographically and laboratory diagnosed obstructive jaundice

Objective
The aim was to assess the value of magnetic resonance cholangiopancreatography (MRCP) before endoscopic retrograde cholangiopancreatography (ERCP) in ultrasonographically and laboratory diagnosed obstructive jaundice.
Background
Obstructive jaundice is highly prevalent in Egypt, resulting in high morbidity, with increasing cost-burden. Numerous investigations are proposed for diagnosis of obstructive jaundice, such as ERCP and MRCP, with high sensitivity and specificity among other investigations, for diagnosing the cause of obstructive jaundice. However, ERCP is considered an invasive method that must be preserved as a life boat for therapy.
Patients and methods
A prospective randomized controlled study was conducted at General Surgery Department, Menoufia University Hospital, on 60 patients divided to two groups. First group patients underwent MRCP (30 patients) before ERCP, and the second group patients underwent ERCP only (30 patients).
Results
In the first group (MRCP±ERCP), scheduled ERCP was canceled in 10 patients of 30 patients (33.3%) owing to negative MRCP detection for stone or tumor. ERCP was done for 20 patients of 30 patients (66.6%), with successful intervention (94.7%) either in extraction of stone (in case of small stones) or stent placement (in large stones or tumors). In the second group, ERCP directly was done for 30 patients. Unnecessary ERCP was done for nine (30%) cases. Success intervention rate for ERCP in detection of stone or malignancy was 90.4%. This study showed a peak increase in accuracy, sensitivity, and specificity after addition of MRCP before ERCP in the diagnosis the cause of obstructive jaundice.
Conclusion
This study showed that MRCP before ERCP is very beneficial, decreases considerably the number of unnecessary ERCP, and decreases postoperative complications of ERCP.