MRCP versus ERCP in the evaluation of patients with suspected bile duct obstruction: A randomized clinical trial

Introduction To evaluate the accuracy of MR cholangiopancreatography (MRCP) in the evaluation of patients with suspected bile duct obstruction (BDO) in the setting of a randomized controlled clinical trial. Methods 205 consecutive patients with suspected BDO (clinical, laboratory, US/CT) were randomized either to MRCP [n=104, 50.73%] or endoscopic retrograde cholangiopancreatography (ERCP) [n=101, 49.27%]. Block randomization was performed according to the suspected level of obstruction at US/CT using sealed envelopes. MRCP examinations were performed using a multicoil array, and a combination of single shot fast spin-echo (coronal, axial, oblique, 5mm-40mm, 256 x 256) and 2D fast spin-echo high-resolution sequences (axial, 3mm, 512 x 256). Results Of the 104 patients randomized to MRCP, 52 (50%) were diagnosed with BDO, while 52 (50%) had no BDO at MRCP. The etiology of BDO at MRCP was as follows: CBD stones (n=28), undetermined distal obstruction (n=13), pancreatic carcinoma (n=2), cholangiocarcinoma (n=2), inflammatory (n=6), and acute pancreatitis (n=1).