Acute Pancreatitis for evaluation of gallstones and it is nondiagnostic, possibly because of obesity, gas, etc, and an MRI could not be performed. Patients with acute biliary pancreatitis may undergo early ERCP for removal of stones causing common bile duct obstruction to reduce disease severity and risk of complications [9,10]. The appropriate timing of ERCP is controversial [9,11]. Some authors argue that if ERCP has to be performed in patients with gallstone-related AP, it should be performed within 72 hours to have the highest chance of mitigating the pancreatic inflammatory process and reducing systemic complications [10]. However, the majority of patients with gallstone pancreatitis suffer from transient obstruction with spontaneous resolution [9]. Approximately half of the patients with cholestatic liver biochemistry and a dilated common bile duct on US or CT did not have a common bile duct stone detected during ERCP [10]. Because ERCP is an invasive procedure that can sometimes lead to complications, including perforation and hemorrhage, accurately identifying those patients with choledocholithiasis who are most likely to benefit from early therapeutic ERCP is important. MRCP images of the biliary system are more sensitive and specific than US for the detection of choledocholithiasis [9,12]. MRCP has a high concordance rate with ERCP for the detection of biliary origin of AP [9]. As such, MRCP prior to ERCP in patients at high risk for choledocholithiasis is common, replacing diagnostic ERCP in many cases. There is conflicting evidence regarding whether the selective use of MRCP in patients at high risk for choledocholithiasis reduces hospital stay and resultant hospital charges [9,13]. MRCP has the added advantage of detecting anatomic anomalies that may contribute to the etiology of AP, such as pancreas divisum or bile duct or pancreatic duct strictures. Therefore, for the assessment of biliary pathology on MRCP, MRI without IV contrast with MRCP may serve as a problem-solving tool.
Acute Pancreatitis. Acute Pancreatitis for evaluation of gallstones and it is nondiagnostic, possibly because of obesity, gas, etc, and an MRI could not be performed. Patients with acute biliary pancreatitis may undergo early ERCP for removal of stones causing common bile duct obstruction to reduce disease severity and risk of complications [9,10]. The appropriate timing of ERCP is controversial [9,11]. Some authors argue that if ERCP has to be performed in patients with gallstone-related AP, it should be performed within 72 hours to have the highest chance of mitigating the pancreatic inflammatory process and reducing systemic complications [10]. However, the majority of patients with gallstone pancreatitis suffer from transient obstruction with spontaneous resolution [9]. Approximately half of the patients with cholestatic liver biochemistry and a dilated common bile duct on US or CT did not have a common bile duct stone detected during ERCP [10]. Because ERCP is an invasive procedure that can sometimes lead to complications, including perforation and hemorrhage, accurately identifying those patients with choledocholithiasis who are most likely to benefit from early therapeutic ERCP is important. MRCP images of the biliary system are more sensitive and specific than US for the detection of choledocholithiasis [9,12]. MRCP has a high concordance rate with ERCP for the detection of biliary origin of AP [9]. As such, MRCP prior to ERCP in patients at high risk for choledocholithiasis is common, replacing diagnostic ERCP in many cases. There is conflicting evidence regarding whether the selective use of MRCP in patients at high risk for choledocholithiasis reduces hospital stay and resultant hospital charges [9,13]. MRCP has the added advantage of detecting anatomic anomalies that may contribute to the etiology of AP, such as pancreas divisum or bile duct or pancreatic duct strictures. Therefore, for the assessment of biliary pathology on MRCP, MRI without IV contrast with MRCP may serve as a problem-solving tool.