TORONTO -- Magnetic resonance imaging is as effective for ruling out
bile duct obstructions and stones as the conventional endoscopic method, based on results from a randomized study of 257 patients.
Lee et al., "Comparison of the efficacy of covered versus uncovered metallic stents in treating inoperable malignant common
bile duct obstruction: a randomized trial," Journal of Vascular and Interventional Radiology, vol.
In the first case, the patient had a very short history of portal hypertension and radiological findings clearly demonstrated by extrahepatic
bile duct obstruction that resulted in intrahepatic biliary duct dilatation, sludge and calculi formation.
Prospective evaluation of magnetic resonance cholangiopancreatography in patients with suspected
bile duct obstruction. 1998; Gut 43: 680-683
As opposed to
bile duct obstruction caused by an internal stone, Mirizzi syndrome is defined as duct obstruction due to external compression from a stone or inflammation in the infundibulum of the gallbladder or a cholecysto-choledochal fistula, said Dr.
Cotton, "Randomised trial of endoscopic stenting versus surgical bypass in malignant low
bile duct obstruction," The Lancet, vol.
Furthermore, the procedure can be used in cases with inaccessible papilla because of malignant duodenal stenosis or with complete lower
bile duct obstruction. According to a systemic review [10], the cumulative technical success rate, functional success rate, and the adverse event rate associated with EUS-BD are 94.71%, 91.66%, and 23.32%, respectively.
Bile duct obstruction due to portal biliopathy in extrahepatic portal hypertension: Surgical management.
Overall, after all diagnostic tests were completed, it was found that about a third of the patients in the study did not have a
bile duct obstruction. How MRCP and ERCP Compare Overall diagnostic Sensitivity Specificity accuracy For diagnosing bile MRCP 96.0% 85.5% 89.7% duct obstruction ERCP 87.2% 100% 93.7% For diagnosing MRCP 85.7% 89.5% 88.8% choledocholithiasis ERCP 84.6% 100% 94.7% For ruling out MRCP 98.0% 89.3% 93.5% disease ERCP 86.8% 100% 93.7% Source: Dr.
Once biliary sludge formed,
bile duct obstruction is aggravated.
Patients with jaundice due to irresectable hilar cholangiocarcinoma underwent percutaneous transhepatic cholangiography (PTC) and biliary stenting as the initial procedure, while those with
bile duct obstruction below the hilum had endoscopic retrograde cholangiopancreatography (ERCP) and stenting as the initial procedure.