MRCP: Stop Already.

Conclusions MRCP has a high rate of false normal results compared with IOC and is not as accurate as more invasive techniques. There is no need for preoperative MRCP in patients with suspected choledocholithiasis caused by stones. MRCP (magnetic retrograde cholangiopancreatography)  is a costly imaging modality (although one would have no idea how much it costs due to pricing opacity and lack of published data---I spent 30 minutes googling "how much does an MRCP cost" without finding a reliable estimate, try it yourself).  I have found it to be one of the most overused studies in modern American medicine.  Typically a GI doc or a surgeon will order one when there is pre-op suspicion of choledocholithiasis (stone in the common bile duct).  The idea is that by getting the MRCP, and it is positive, then one can proceed to ERCP/stone extraction with a certain degree of confidence.  Similarly, a negative result gives the surgeon a mandate to proceed straight to the OR for lap chole.  The problem, as the above study shows, is that MRCP studies are highly unreliable.  I can't tell you how many times I have obtained intra-operative cholangiograms on patients with ostensibly normal bile ducts (based on a pre-op MRCP) who were found to have....stones in the CBD. The problem is that not enough surgeons perform routine intra-operative cholangiography.   Those who don't  do it on every case will miss a certain percentage of CBD stones (overal...
Source: Buckeye Surgeon - Category: Surgeons Authors: Source Type: blogs