Additionally, studies that compare MRCP to ERCP use ERCP as the gold standard, which intrinsically biases the results toward ERCP. In patients with previous gastroenteric anastomoses, MRCP is accurate in evaluating the extrahepatic biliary ductal system with superior accuracy compared to ERCP or EUS that is due to technical difficulties in being able to advance the endoscope into the biliopancreatic limb. MRCP is less morbid than ERCP imaging; however, ERCP imaging offers the potential for intervention (CBD stone extraction or biopsy of an obstructing lesion). MRCP is more sensitive than US for determining the cause of biliary obstruction when dilated bile ducts are seen on US [61]. In patients with suspected sclerosing cholangitis or biliary stricture, MRCP is the preferred imaging modality, avoiding the possibility of suppurative cholangitis that may be induced by endoscopic catheter manipulation of an obstructed biliary system [53]. MRCP findings may guide directed approaches, such as ERCP, with brushing, percutaneous transhepatic biliary stenting, or reconstructive surgery [34,51-53,62,63]. Jaundice ERCP ERCP is an invasive procedure that is typically performed by gastroenterologists or general surgeons in an interventional suite or operating room under general anesthesia and requires advancing an endoscope into the duodenum, with cannulation of the ampulla and injection of contrast into the CBD with fluoroscopic images obtained to image the biliary tree. ERCP may be performed with a concomitant sphincterotomy, biopsy, or stent deployment (CBD or pancreatic). ERCP is the most commonly performed invasive diagnostic and therapeutic biliary procedure. Because of significant advances in cross-sectional imaging, in particular the advent of MRCP, ERCP currently has more of a therapeutic role [65-67]. ERCP is not useful in the setting of jaundice caused by suspected hepatitis/sepsis, alcoholic liver disease, or in the case of medical drug toxicity.
Jaundice. Additionally, studies that compare MRCP to ERCP use ERCP as the gold standard, which intrinsically biases the results toward ERCP. In patients with previous gastroenteric anastomoses, MRCP is accurate in evaluating the extrahepatic biliary ductal system with superior accuracy compared to ERCP or EUS that is due to technical difficulties in being able to advance the endoscope into the biliopancreatic limb. MRCP is less morbid than ERCP imaging; however, ERCP imaging offers the potential for intervention (CBD stone extraction or biopsy of an obstructing lesion). MRCP is more sensitive than US for determining the cause of biliary obstruction when dilated bile ducts are seen on US [61]. In patients with suspected sclerosing cholangitis or biliary stricture, MRCP is the preferred imaging modality, avoiding the possibility of suppurative cholangitis that may be induced by endoscopic catheter manipulation of an obstructed biliary system [53]. MRCP findings may guide directed approaches, such as ERCP, with brushing, percutaneous transhepatic biliary stenting, or reconstructive surgery [34,51-53,62,63]. Jaundice ERCP ERCP is an invasive procedure that is typically performed by gastroenterologists or general surgeons in an interventional suite or operating room under general anesthesia and requires advancing an endoscope into the duodenum, with cannulation of the ampulla and injection of contrast into the CBD with fluoroscopic images obtained to image the biliary tree. ERCP may be performed with a concomitant sphincterotomy, biopsy, or stent deployment (CBD or pancreatic). ERCP is the most commonly performed invasive diagnostic and therapeutic biliary procedure. Because of significant advances in cross-sectional imaging, in particular the advent of MRCP, ERCP currently has more of a therapeutic role [65-67]. ERCP is not useful in the setting of jaundice caused by suspected hepatitis/sepsis, alcoholic liver disease, or in the case of medical drug toxicity.