MRCP vs ERCP

[spyyder]

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Will MRI/MRCP eventually replace ERCP? Could GI end up losing this procedure to IR docs?

 

[phllystyl]

can you do a sphincterotomy and place a stent while in MR?

 

[Whisker Barrel Cortex]

MRCP is not an invasive procedure and not done by IR docs. Its basically a heavily T2 weighted abdominal MRI which shows the biliary and pancreatic ductal system to better advantage. You cannot treat patients using this technique.

It basically has its major niche in the subgroup of patients with possible biliary obstruction or choledocolithiasis, but not definite findings. If you know there's something wrong (highly dilated duct, severe symptoms, etc), you go to ERCP. If the findings are equivocal or the patient is high risk (85 y/o w copd, cad, etc), you can do an MRCP first to see if there really is something to go after. The other use is for monitoring of primary sclerosing cholangitis, biliary tumors, or for evaluation of the pancreatic duct.

 

[sbf]

Another use for MRCP is in patients with hyperbilirubinaemia as a CT cholangiogram will not excrete adequately into the biliary system.

My humble view would be that MRCP should only be preferable to ERCP in patients with PSC if they have never required dilation before..... ERCP would be better in this subset as it allows therapeutic intervention if required. Naturally as a periodic follow-up in the absence of symptoms or deranged LFT's an MRCP would be quite acceptable.

As an interventionalist I believe ERCP still has many advantages to MRCP in the majority of patients. If the duct is regular calibre but has mild luminal irregularities or "some sludge" it's easy to cut a sphincterotomy and trawl while there.... not have to get onto another waiting list etc etc

Horses for courses 🙂

 

[sdnetrocks]

1

 

[drdjdesi]

To sum it up, strictly diagnostic ERCP (minus ones with planned brushings) is def out of favor given risks/operator confidence. MRCP is sufficent for simple cases but it invariably results in an ERCP🙂 (Thank god)

 

[salmonella]

Who interprets the MRCP images? Gastroenterologists or radiologists? Is there a turf war going on just like radiologists fighting to read cardiac CT/MRI?

 

[nutcancer]

Who interprets the MRCP images? Gastroenterologists or radiologists? Is there a turf war going on just like radiologists fighting to read cardiac CT/MRI?

radiologists read MRCPs and virtual colonoscopies

and please, cardiologists are fighting to read cardiac CT/MRI

 

[tum]

radiologists read MRCPs and virtual colonoscopies

and please, cardiologists are fighting to read cardiac CT/MRI

where i am, it doesn't seem to be that much of a fight.. ie radiologists get bullied pretty easily because they don't have the patient base.

 

[touchstonemedic]

where i am, it doesn't seem to be that much of a fight.. ie radiologists get bullied pretty easily because they don't have the patient base.

...But they most likely own the CT or the MRI scanner (even where you are).

 

[tum]

...But they most likely own the CT or the MRI scanner (even where you are).

i asked about that and got a very vague answer about group ownership. probably means the cardiologist i asked didn't own it or was sketched out by me asking so many business-related questions : )

 

[elwademd]

Will MRI/MRCP eventually replace ERCP? Could GI end up losing this procedure to IR docs?

mri/mrcp is only for diagnostic purposes. so, while it is a very useful and helpful tool (as alluded to in previous posts), it can't be therapeutic in the way that an ercp can. after all, ercp can be both diagnostic and therapeutic.

some gi docs will tell you that in this day and age, to do an ercp, you need to be prepared to do something... because if not, you should have just ordered an mri/mrcp!

add to that, in some settings, such as patients with pacemakers, you can't get an mri/mrcp, and thus are limited to ct's or ercp's.

 

[tum]

it would make sense that GI docs would self-refer MRCPs and colonoscopies analagous to cardiologists self referring cardiac CT/MRI

ie same reason interventional nephrology is taking off so fast

 

[gida]

gi docs do endoscopic ultrasound...EUS will replace MRCP for evaluating the CBD and PD!!