MRCP versus ERCP


  1. MR cholangiopancreatography is noninvasive and safe, because it does not require anesthesia or injection of intraductal or intravenous contrast agent. On current MR imaging systems high-quality images can be obtained consistently. 
  2. MRCP is useful in patients after incomplete or unsuccessful ERCP. In some patients, such as those who have undergone surgery with biliary enteric anastomosis or Billroth II, it may not be possible to perform ERCP, so MRCP is the modality of choice to evaluate these postsurgical patients.
  3. Unlike ERCP, MRCP produces images of the ducts in their natural state, because it does not involve distention of the ducts by injected contrast medium. ERCP cannot evaluate extraductal structures directly, whereas MRCP can be combined with conventional MR imaging for the evaluation of extraductal disease, such as tumors. 
  4. ERCP has advantages over MRCP, which include direct therapeutic interventional procedures that may be performed concurrent with diagnostic imaging. 
  5. ERCP is generally a safe procedure, but still associated with nonnegligible morbidity and mortality rates. Also, technical failures occur in up to 10% of cases because of unsuccessful cannulation of the common bile duct (CBD) or pancreatic duct. In some institutions MRCP is gradually replacing ERCP as a primary diagnostic imaging modality to evaluate the biliary system and pancreatic duct.

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