Introduction Secretin enhanced magnetic resonance cholangio-pancreatography (S-MRCP) has been used as part of the diagnostic algorithm for the diagnosis of patients presenting with acalculous biliary type abdominal pain (ABAP); the exact role of this diagnostic modality is unclear. The aim of this study was to assess the diagnostic yield of S-MRCP in a large HPB tertiary referral centre in the investigation of patients with ABAP.
Methods Retrospective analysis of a prospectively maintained database of all patients presenting with ABAP in whom a S-MRCP was requested from June 2008 to May 2013. The findings of S-MRCP were compared with those of MRCP and EUS (performed prior to S MRCP) and the diagnostic yield of S-MRCP in the work up of a patient presenting with ABAP was estimated.
Results Of the 117 patients with ABAP [28 males and 89 female; mean age 48 yrs] were referred for S-MRCP, 114 (97.4%) patients successfully completed the scan. Of these 37 patients who had a normal MRCP, S-MRCP identified significant findings in 8 (22%) patients (Table 1). In the present study 78 (67%) patients had EUS. Out of the 41 patients who had a normal EUS, S-MRCP was able to identify significant pathology in 21 (54%) patients (Table 1).
Conclusion This study suggests that S-MRCP has a 22 and 54% additional diagnostic yield in ABAP patients who have a normal MRCP and a normal EUS respectively. The commonest abnormality identified in these patients on S-MRCP was obstruction at ampulla or proximal PD. S-MRCP should be considered in the diagnostic algorithm of patients with ABAP.
References 1 Mariani A, Arcidiacono PG, Curioni S, et al. Diagnostic yield of ERCP and secretin-enhanced MRCP and EUS in patients with acute recurrent pancreatitis of unknown aetiology. Dig Liver Dis 2009 Oct;41(10):753-8
2 Matos C, Metens T, Devière J, et al. Pancreas divisum: evaluation with secretin-enhanced magnetic resonance cholangiopancreatography. Gastrointest Endosc 2001 Jun;53(7):728-33
Disclosure of Interest None Declared.
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