Abstract
Introduction
The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the investigation of common bile duct (CD) calculi were evaluated using “evidence-based practice” (EBP) methods.
Methods
A focused clinical question was constructed. A structured search of primary and secondary evidence was performed. Retrieved studies were appraised for validity, strength and level of evidence (Oxford/CEBM scale: 1–5). Retrieved literature was divided into group A; MRCP slice thickness ≥5 mm, group B; MRCP slice thickness = 3 mm or 3D-MRCP sequences.
Results
Six studies were eligible for inclusion (3 = level 1b, 3 = level 3b). Group A: sensitivity and specificity of MRCP and EUS were (40%, 96%) and (80%, 95%), respectively. Group B: sensitivity and specificity of MRCP and EUS were (87%, 95%) and (90%, 99%), respectively.
Conclusion
MRCP should be the first-line investigation for CD calculi and EUS should be performed when MRCP is negative in patients with moderate or high pre-test probability.
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Acknowledgments
The author would like to thank Dr R. Gibney for highlighting this important clinical question to the group and in assisting in formulation of the structured clinical questions used to search the literature and Dr. D. Malone for his assistance with project completion and manuscript preparation.
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C. J. McMahon is a fifth year trainee (Fellow) in the programme of the Faculty of Radiologists, Royal College of Surgeons in Ireland and learned EBP techniques in the St Vincent’s University Hospital EBP group.
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McMahon, C.J. The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound in diagnosis of common bile duct calculi: a critically appraised topic. Abdom Imaging 33, 6–9 (2008). https://doi.org/10.1007/s00261-007-9304-3
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DOI: https://doi.org/10.1007/s00261-007-9304-3