Re: MRCP vs ERCP vs Liver Biopsy

June 19, 2008

Hi Eva,

At my hospital, ERCPs are mainly used for interventions (rather than

to satisfy a doc's curiousity or just to 'explore'), because of the

risks associated with the procedure. It sounds like your husband's

doc is trying to get a more definitive diagnosis in the least

invasive manner possible. If he gets good images in the MRCP and

sees the classic beaded ducts, he may be satisifed with that for a

temporary dx (it may be confirmed later upon ERCP, when that

procedure is needed), and he can avoid having any further invasive

procedures for now. If the MRCP images aren't good enough--which can

happen sometimes--or don't show exactly what he wants to see, he may

proceed to ERCP. Even if he does get great images with the MRCP, he

may need to go ahead with an ERCP if he feels that some sort of

intervention in his ducts is necessary--balloon dilations, stenting,

etc.

ERCPs are pretty much considered the 'gold standard' in the dx of

PSC. If he doesn't find evidence of PSC on an ERCP, I'm not sure why

he would want to go on to a liver biopsy. Maybe someone else can

help with that one....?

HTH,

Genevieve

UC 1983, J-Pouch 1999, PSC 12/07

*Another thought: at my hospital the docs always want to have at

least one non-invasive imaging study done before proceeding to ERCP,

unless it is a scheduled ERCP for a specific reason. So even if I'm

feeling unwell and we're pretty sure I need a new stent, my doc will

STILL order an MRCP first to have backup justification for why the

ERCP is needed.

> Would it be possible for MRCP results to be fine and then a person

still being diagnosed with PSC through ERCP or liver biopsy (as

opposed to something showing up through MRCP and being confirmed

later)? How about ERCP and liver biopsy? How many of you have had

this sort of experience? Why would they do MRCP in the first place

if they 'don't believe the results'?

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