Is There a Difference in Diagnostic Accuracy and Clinical Impact between Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography?

Background and Study Aims: It is still unknown whether there is a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP).
Patients and Methods: The test performance and potential clinical impact of EUS and MRCP, had each investigation been performed as the first examination method, were compared prospectively in 163 patients admitted for and examined by endoscopic retrograde cholangiopancreatography (ERCP).
Results: The accuracies of EUS and MRCP were 0.93 and 0.91, respectively (no significant difference, P > 0.05). Had EUS or MRCP been performed as the first investigation in the 75 patients who had a presumed high probability for needing therapeutic ERCP, only 15 and nine patients, respectively, would have avoided ERCP. In this group of patients, one patient needed other diagnostic investigations following EUS compared with 11 patients following MRCP (P = 0.004). For the 57 patients with an intermediate probability of needing endoscopic therapy, EUS and MRCP would have spared 37 and 38 patients, respectively, from the need to have an ERCP. In 31 patients with a presumed low risk of needing endoscopic therapy, 30 and 29 patients would have been spared from ERCP had EUS and MRCP, respectively, been performed initially.
Conclusions: There was no difference in the diagnostic accuracy and clinical impact between EUS and MRCP in the majority of the patients. The impact of EUS or MRCP on the ERCP workload was highly dependent on the presumed probability of needing endoscopic therapy.

References

• 1 Ponchon T, Pilleul F. Diagnostic ERCP.  Endoscopy. 2002;  34 29-42
• 2 de Ledinghen V, Lecesne R, Raymond J M. et al . Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study.  Gastrointest Endosc. 1999;  49 26-31
• 3 Materne R, Van Beers B E, Gigot J F. et al . Extrahepatic biliary obstruction: magnetic resonance imaging compared with endoscopic ultrasonography.  Endoscopy. 2000;  32 3-9
• 4 Rösch T, Meining A, Fruhmorgen S. et al . A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures.  Gastrointest Endosc. 2002;  55 870-876
• 5 Scheiman J M, Carlos R C, Barnett J L. et al . Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis.  Am J Gastroenterol. 2001;  96 2900-2904
• 6 Ainsworth A P, Mortensen M B, Durup J. et al . Clinical impact of endoscopic ultrasonography at a county hospital.  Endoscopy. 2002;  34 447-450
• 7 Altman D G. Practical statistics for medical research. London; Chapman and Hall 1991
• 8 Gress F G, Hawes R H, Savides T J. et al . Role of EUS in the preoperative staging of pancreatic cancer: a large single-center experience.  Gastrointest Endosc. 1999;  50 786-791
• 9 Mertz H R, Sechopoulos P, Delbeke D. et al . EUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma.  Gastrointest Endosc. 2000;  52 367-371
• 10 Burtin P, Palazzo L, Canard J M. et al . Diagnostic strategies for extrahepatic cholestasis of indefinite origin: endoscopic ultrasonography or retrograde cholangiography? Results of a prospective study.  Endoscopy. 1997;  29 349-355
• 11 Erickson R A, Garza A A. EUS with EUS-guided fine-needle aspiration as the first endoscopic test for the evaluation of obstructive jaundice.  Gastrointest Endosc. 2001;  53 475-484
• 12 Menon K, Barkun A N, Romagnuolo J. et al . Patient satisfaction after MRCP and ERCP.  Am J Gastroenterol. 2001;  96 2646-2650
• 13 Sahai A V, Devonshire D, Yeoh K G. et al . The decision-making value of magnetic resonance cholangiopancreatography in patients seen in a referral center for suspected biliary and pancreatic disease.  Am J Gastroenterol. 2001;  96 2074-2080
• 14 Farrell R J, Noonan N, Mahmud N. et al . Potential impact of magnetic resonance cholangiopancreatography on endoscopic retrograde cholangiopancreatography workload and complication rate in patients referred because of abdominal pain.  Endoscopy. 2001;  33 668-675
• 15 Tanner A R, Dwarakanath A D, Tait N P. The potential impact of high-quality MRI of the biliary tree on ERCP workload.  Eur J Gastroenterol Hepatol. 2000;  12 773-776