Impact of magnetic resonance cholangiography on endoscopic therapy before and after laparoscopic cholecystectomy.

ABSTRACT

OBJECTIVE: To assess the impact of magnetic resonance cholangiography (MRC) on endoscopic therapy before and after laparoscopic cholecystectomy (LC). METHODS: Ninety-six patients were referred for endoscopic retrograde cholangiography (ERC) before or after LC because of abnormal liver function tests, raised serum amylase, or abnormal ultrasound scan (USS) of the biliary system. All patients underwent MRC before ERC. RESULTS: Common bile duct (CBD) stones were detected in 48 patients on ERC, 40 on MRC, and 23 on USS. The CBD was dilated on ERC (> 8 mm) in 59 patients, on MRC (> 7 mm) in 51, and on USS (> 7 mm) in 42. Abnormal CBD (dilated +/- stone) was detected in 69 patients on ERC, 57 on MRC, and 44 on USS. Intrahepatic ducts were dilated on ERC in 26 patients, on MRC in 24, and on USS in 18. The study was abnormal on ERC in 81 patients, on MRC in 63, and on USS in 51. Endoscopic therapy was attempted in 80 patients. Presence of CBD stone (p = 0.03), dilated CBD (p = 0.01), abnormal CBD (p = 0.0007), and abnormal study (p = 0.0004) on MRC were significantly related to endoscopic therapy. In 6 cases LC was deferred because MRC revealed CBD calculi which could not be cleared endoscopically. ERC could have been avoided in 14/ 19 patients who did not benefit from it. CONCLUSION: MRC findings are significantly related to endoscopic therapy in patients referred for ERC before and after LC, and they influence therapeutic decisions in some of them.